Clinical Analysis of restrictive strabismus secondary to ophthalmic surgery

Background: This study aimed to report the clinical characteristics and surgical methods of restrictive strabismus secondary to ophthalmic surgery. Methods: This retrospective case series covered 14 restrictive strabismus cases secondary to ophthalmic surgery. After evaluation of the clinical history and the basic ophthalmological findings, the following parameters were examined: squint angles (prism with alternative cover test, Krimsky’s test or Maddox cross), ocular motility, duction test and the forced duction test. All paitients underwent surgery, the strabismus surgery included the excision of adhesions and scar tissue, adhesiolysis, medial and lateral ligaments separated, repositioning of extraocular muscles (according to the degree of deviations). We described the clinical characteristics and evaluated the surgical results in strabismus eyes. Results: All patients were satisfied with the results of surgery, obtained anatomical reduction and partial functional recovery. In nine cases with preoperative diplopia, eight cases had no diplopia after surgery and one patient’s diplopia disappeared after the secondary surgery. The other five cases without preoperative diplopia, but had restricted ocular motility, which improved significantly than before surgery. Conclusions: Orbital surgery, trauma, conjunctival surgery, strabismus surgery and so on, can lead to secondary restrictive strabismus surgery. Strabismus surgical treatments including the full removal of the muscles around the scar, adhesiolysis, medial and lateral ligaments separated, eye muscle surgery, can provide excellent results and patient’s satisfaction.

Surgical Treatment of Combined Instability of the Knee Joint Caused by Damage to Three Stabilizing Ligaments (ACl, PCL, MCL). Clinical case

This article presents a clinical case of combined injury of three ligaments (anterior and posterior cruciate and medial lateral ligaments) in a 46-year-old overweight woman (BMI = 38). The late diagnosed damage to the ligaments and the lack of conditions for their normal recovery led to combined instability of the knee joint and the appearance of indications for their reconstruction. At the moment, 6 weeks after the operation, the patient began to step independently on the operated limb, the range of permissible movements in the knee joint was flexion up to 90 degrees. The planned period of full recovery is 24 weeks. Key words: combined knee joint instability, posterior cruciate ligament, medial lateral ligament, anterior cruciate ligament, knee injury, clinical case.

Clinical Outcomes and Return to Sport After Minimally Invasive Reconstruction of the Lateral Ligament Complex with Semitendinosus Tendon Autograft in Chronic Lateral Ankle Instability

<p>Background: Ankle sprains are common, affecting especially the lateral ligament complex of the ankle, often leading to chronic symptoms and instability. Many procedures have been described for chronic ankle instability. This study analyses clinical outcomes and returns to sport in patients who underwent minimally invasive reconstruction of the lateral ligaments complex of the ankle with a semitendinosus tendon autograft.</p><p>Methods: Twenty-three patients (mean age: 33.9 years) with grade 3 lesion of both anterior-talofibular (ATFL) and calcaneofibular (CFL) ligaments, underwent minimally invasive reconstruction of the ATFL and CFL ligaments with an ipsilateral semitendinosus tendon autograft. They were retrospectively reviewed and return to sport was evaluated with the Halasi ankle activity scale.</p><p>Results: The mean follow-up was 30 months (range 26-53 months). The mean AOFAS score increased from 68.6 to 95.3 point. The average VAS decreased from 3.6 to 1.3. The Halasi score changed from 5.0 to 5.1. Excepts for Halasi, the differences were statistically significant (p <0.001).19 patients judged the received treatment as excellent, 2 as good. No revision procedures were performed. No major complications were reported.</p> <p>Conclusions: This study confirms good clinical and sports outcomes following minimally invasive reconstruction of the lateral ligaments complex of the ankle with a semitendinosus autograft.</p>

Assessment of incidence of recurrence and constipation in patients of rectal prolapse undergoing rectal mobilization only with division of lateral stalks

Background: Rectal prolapse is a pelvic floor disorder that can occur in men and women of all ages. It results in pain, bleeding per rectum, seepage, diarrhoea or constipation and a disabled quality of life. With the advent of twentieth century, perineal operative procedures have become more common. Perineal procedures though have lower morbidities but have higher recurrence rate and high incidence of post-operative constipation. Novel abdominal approaches to rectal prolapse repair also became common during the first half of this century. Numerous types of surgical procedures have been attempted. Most techniques developed till now have some advantages and some short comings. CT Speakman and Pollen et al have shown in their studies that division of lateral ligaments caused new onset constipation and they attributed this effect to denervation of rectum. As the issue of recurrence and post-operative constipation remained unsettled.Methods: This was an observational study to assess the incidence of recurrence and post-operative constipation in patients of rectal prolapse. In well selected patients, we performed complete rectal mobilization with division of lateral ligaments. We assessed the patients on the basis of Clevland clinical constipation scoring system.Results: Out of 25 patients, 4 patients developed constipation, 2 had mild and 2 had moderate constipation and 2 patients had recurrence. Patients were kept under six monthly follow-up till a period of eighteen months.Conclusions: Only rectal mobilization with division of lateral ligaments can be a good surgical option in patients of rectal prolapse not having severe constipation.

ADAPTIVE TRANSFORMATIONS OF A FOX’S KNEE JOINT LIGAMENTS UNDER CHANGED FUNCTIONAL CONDITIONS

The aim of the research is identification of complex structural changes of the fox’s knee joint ligaments to ensure its high biomechanical potencies. A promising approach for the study of adaptive and compensatory changes of the joint as a multicomponent biomechanical system is to evaluate the structural transformations of its ligaments under conditions of a new functional load. The research was carried out on the basis of the Department of Animal Anato-my and Histology named after Professor A. F. Klimov «Moscow state Academy of Veterinary Medicine and Biotech-nology – MBA named after K. I. Scryabin» and on the basis of JSC «Breeding animal farm «Saltykovsky». The arti-cle presents information about morphological transformations of the lateral and median ligaments of the knee joint that determine its reliable stability. Numerous structural changes of the fox ligaments during cage housing is re-flected, which decrease in the thickness of bundles of collagen fibers and their compositional density compared to the standard structure (in wild individuals). Morphological transformations that can significantly reduce the strength and elasticity resistance of the ligaments and the biomechanical potential of the joint are shown. 23 fox individuals, including 15 individuals of the cage housing and 8 representatives of the natural habitat were studied. The re-search used a comprehensive methodological approach, including anatomical preparation, light microscopy of histological sections, scanning electron microscopy, micromorphometry and statistical analysis of the obtained digi-tal data. According to the results of the study, it was found that fox individuals from natural biocenosis, have colla-gen structures of the lateral ligaments different in waving and packing density from ones of cage housing, which can contribute to ensuring their biomechanical domination.

Ossicle resection and anatomic reconstruction of lateral ligaments for chronic ankle instability with large accessory malleolar ossicles

BackgroundAccessory malleolar ossicles are often found in patients with chronic ankle instability. For the large ossicles more than 10mm, there are still uncertainties about the suitable surgical option.This study was aimed at evaluating the clinical efficacy of ossicle resection and anatomic reconstruction of the lateral ligaments for chronic ankle instability with large accessory malleolar ossicles.MethodsSixteen chronic ankle instability patients with large accessory malleolar ossicles were treated with ossicle resection and anatomic reconstruction of lateral ligaments between December 2014 and February 2018. The clinical effects were evaluated with Visual Analogue Scale, Karlsson-Peterson ankle scoring system, and subjective satisfaction of patients. The varus talar tilt angle and anterior talar displacement between bony surfaces of the tibia and talus were included as radiographic parameters.ResultsThere were 11 males and 5 females in this study group. The average age at the time of surgery was 28.9 years old. The average final follow-up time was 26.9 months (range, 12 to 47). The average size of the ossicles was 11.7mm. The VAS score declined from 3.5 ± 1.6 preoperatively to 1.4 ± 1.0 at the final follow up (p < 0.01). The Karlsson-Peterson score was significantly improved from 52.7 ± 15.1 before surgery to 86.4 ± 8.2 at the last follow up (p < 0.01). Radiologically, the average varus talar tilt angle was decreased from 15.4 ± 2.0 degrees preoperatively to 6.2 ± 1.6 degrees at the final follow up (p < 0.01), and the average anterior talar displacement was decreased from 14.3 ± 2.1 mm preoperatively to 6.3 ± 1.4 mm at final follow up (p < 0.01). Fourteen patients (87.5%) were satisfied (‘excellent’ or ’good’) with treatment outcome.ConclusionsOssicle resection and anatomic reconstruction of the lateral ligaments provided good clinical outcomes for chronic ankle instability with large accessory malleolar ossicles. This method appears to be one of the reliable and effective procedures for the treatment of chronic ankle instability with large accessory malleolar ossicles.