1/6. Second-look arthroscopy with removal of bioabsorbable tacks.Eleven years after tearing her anterior cruciate ligament (ACL) (not reconstructed), a 36-year-old dancer reinjured her knee and required arthroscopic ACL reconstruction. At arthroscopy, the medial meniscus had a bucket-handle tear that was repaired by using three bioabsorbable tacks. The ACL was then repaired in the usual manner. Because of persistent posterior knee pain throughout her rehabilitation, we performed "second-look" arthroscopy 14 weeks after reconstruction. The meniscus had healed and was stable; however, tack motion was evident and the tacks were easily removed. Inspection of the tacks showed that the barbs had been resorbed. The patient recovered uneventfully, and pain-free flexion 28 days after surgery was 0 degrees-136 degrees. We believe this to be the first reported case demonstrating the early stages of tack degradation in meniscal repair.- - - - - - - - - - ranking = 1keywords = ligament (Clic here for more details about this article) |
2/6. Periarticular heterotopic ossification after multiple knee ligament reconstructions. A report of three cases.Heterotopic ossification is a frequently encountered clinical and radiographic entity. There are no previous reports in the English literature of heterotopic ossification after arthroscopically assisted ligament reconstructions for knee dislocations. Further, a link between the PCL reconstruction and posterior capsular ossification has not been heretofore recognized. Our three cases should raise the clinical awareness of such an entity.- - - - - - - - - - ranking = 5keywords = ligament (Clic here for more details about this article) |
3/6. Preperitoneal collection after endoscopic extraperitoneal inguinal hernioplasty in a patient with malignant ascites.Painful preperitoneal collection is a rare complication following endoscopic totally extraperitoneal inguinal hemioplasty. Here we present the case of a woman who underwent endoscopic extraperitoneal inguinal hernioplasty for a left inguinal hernia. Her past health was good. During the dissection of the extraperitoneal space, clear ascitic fluid was noted upon breaching the peritoneum near the round ligament. Endoscopic stapling was used to close the peritoneal tear, and the procedure was completed uneventfully. The patient complained of left iliac pain after the operation. A physical examination showed no swelling over the left iliac fossa. Contrast computed tomography of the abdomen revealed preperitoneal fluid collection over the hernioplasty site and a small amount of ascites. Expectant treatment with pain control by oral analgesics was adopted. A follow-up CT scan 4 months after the operation showed resolution of the preperitoneal fluid collection but with increased ascites. Abdominal paracentesis with peritoneal fluid for cytology analysis found adenocarcinoma cells. The patient succumbed to a terminal malignancy a year after surgery. Conversion of endoscopic extraperitoneal inguinal hernioplasty to open repair should be considered upon intraoperative discovery of ascites. Painful preperitoneal collection is a possible sequela following endoscopic extraperitoneal hernioplasty in patients with malignant ascites.- - - - - - - - - - ranking = 1keywords = ligament (Clic here for more details about this article) |
4/6. Symptomatic anomalous insertion of the medial meniscus.We report a case of a young athlete with a symptomatic anomaly of the medial meniscus. An anomalous portion in conjunction with the anterior horn of the medial meniscus extended to the intercondylar notch of the femur through the surface of the anterior cruciate ligament. This anomalous band was arthroscopically resected and the symptoms completely disappeared. Histologic examination showed fibrocartilaginous tissue compatible with meniscus.- - - - - - - - - - ranking = 1keywords = ligament (Clic here for more details about this article) |
5/6. Incidences of frostbite in arthroscopic knee surgery postoperative cryotherapy rehabilitation.A retrospective study of 4 cases of frostbite was undertaken to examine causes and to identify related contributory behaviors and circumstances. These patients underwent various surgical interventions before the onset of frostbite during similar postoperative care regimens. Surgical procedures included some of the following in each patient: lateral retinacular release, vastus medialis oblique muscle advancement, partial medial meniscectomy, chondromalacia patella, trochlea, medial and lateral femoral condyle debridement, lateral retinaculum release, and excision of medial plica. The mechanism of onset, development, and sites of frostbite were uniform in all patients. In every case, the sites were located in the area on top of the patella including some adjacent regions depending on the size of each injury. frostbite locations were correlated with the part of the cryotherapy cold cuff device located on top of the patellar region. This cuff portion was originally designed to accommodate surgical trauma induced during autogenous bone-tendon-bone graft harvest in anterior cruciate ligament reconstruction surgery. Locating cryotherapy over this region assisted in minimizing pain and effusion for patients subsequent to distal patella bone plug harvest trauma. However, the requirement for use of the pad in the patella area for patients not undergoing anterior cruciate ligament reconstruction with autograft was found to be unnecessary and was the primary cause of frostbite in the cases presented here.- - - - - - - - - - ranking = 2keywords = ligament (Clic here for more details about this article) |
6/6. Two unusual cases of postcholecystectomy pain.I report on two patients who were initially diagnosed with sphincter of oddi dysfunction (S.O.D.) because of postcholecystectomy pain in the right upper quadrant; both had other causes of pain. One patient had an aberrant hepatic duct that drained into a remnant of the cystic duct resulting in formation of stones. The second patient had adhesions of the stomach to the liver with the ligamentum teres bowing across the antrum. Gastroenterologists and endoscopic surgeons should be aware of causes of postcholecystectomy pain that are unrelated to sphincter of oddi dysfunction.- - - - - - - - - - ranking = 1keywords = ligament (Clic here for more details about this article) |