Arthroscopic ACL Avulsion Fixation With Adjustable Loop Length Cortical Endobutton.

Various surgical management techniques have been introduced to treat anterior cruciate ligament avulsion fractures. There is disagreement among orthopedic surgeons about which fixation device to use during arthroscopy. Recently, there has been an increase in the use of arthroscopic techniques for fixation, and different devices such as sutures, screws, and fiber wires are being considered. The development of fiber wires has made it possible to use them in comminuted avulsions with satisfactory stability, whereas screws cannot be used in such cases. Sutures do not provide adequate stability for early range of motion compared to other methods. The article then goes on to describe a specific arthroscopic fixation technique that uses an adjustable loop cortical button to manage the avulsed fragment and provide stability.

Simultaneous Tunnel Grafting and Anterior Cruciate Ligament Reconstructions Revision Using Double Suspensory Fixation: A Single-Stage Solution.

The anterior cruciate ligament (ACL) is often vulnerable to sports-related injuries, leading to numerous ACL reconstructions (ACLRs) annually in the United States. Although largely successful, these procedures face the risk of recurrent instability due to graft failure. ACLR failures are typically attributed to technical errors and patient-related factors, with improper positioning of the tibial and femoral tunnels as the most common technical mistake. Current 2-stage revision techniques involve primary bone grafting followed by secondary tendon graft placement, resulting in increased costs and extended rehabilitation times. This article proposes a single-stage revision strategy involving simultaneous tunnel grafting and ACLR revision. The method employs double suspensory fixation by adjustable loop buttons, thereby eliminating the dependence on metaphyseal bone stock for stable graft fixation. This new procedure may offer a more efficient and cost-effective approach, reducing the need for a second surgery and potentially allowing patients to return to normal activities more quickly.

Distal Kaplan Fiber Tenodesis Surgical Technique.

Anterior cruciate ligament tears are a common knee injury, and even after reconstruction, some patients may still experience instability in their knee. To address this, extra-articular reinforcement may be necessary to prevent anterior translation and internal rotation of the tibia. Kaplan fibers (KFs), which are the attachments of the iliotibial band to the distal femur, can help improve anterolateral rotatory stability in the knee, especially in greater degrees of knee flexion. Our technique for KF reconstruction involves making a 10-cm incision in the skin and subcutaneous tissue of the distal and lateral thigh. We release a 10-cm × 1-cm strip of the iliotibial band while maintaining its tibial insertion and then stitch the free end of the strip before attaching it to the distal femur using a ToggelLoc (Zimmer Biomet). The advantage of this technique is that the tension of the iliotibial band strip can be adjusted using the ToggelLoc, allowing the surgeon to increase tension in the graft as needed to achieve ideal tension in knee flexion.

The Effect of Intramedullary vs Extramedullary Tibial Guides on the Alignment of Lower Extremity and Functional Outcomes Following Total Knee Arthroplasty: A Randomized Clinical Trial.

Objectives: Total knee arthroplasty (TKA) has been known as a definitive treatment for advanced knee osteoarthritis. Both intramedullary (IM) and extramedullary (EM) tibial guides have been used to restore the desired extremity alignment. However, controversy exists regarding the superiority of either technique We aimed to compare the functional outcomes and accuracy of IM and EM tibial guides in providing neutral alignment after TKA. Methods: In a randomized, double-blinded clinical trial, we studied 98 patients undergoing primary TKA in two groups of IM and EM. We measured the medial proximal tibial angle (MPTA), varus angle (VA), and joint-line convergence angle with normal ranges of 90°±3°, 0-2°, and 0±3°, respectively, on a three-joint alignment view after three months. We also assessed the functional outcomes at the last follow-up. Finally, we compared these outcomes between the two groups. Results: Eighty-four patients (IM=42, EM=42) were included in the final analysis (16 males, 68 females, mean age: 63.9±8.6 years, mean follow-up: 13±2.9 months). The mean postoperative (post-op) alignment angles showed no significant difference, although MPTA outliers were significantly more frequent in the EM group (26.2% vs. 9.5% in IM, P=0.04). None of the functional outcomes showed a significant difference between the two groups. However, the mean increase in knee range of motion (ROM) was significantly higher in the knees with VAs within ±3° of neutral than those outside this range (30.8 vs. 27.4, respectively, P=0.039). Conclusion: We conclude that both techniques were not different regarding the mean alignment angles and functional outcomes. However, fewer MPTA outliers can be seen with the IM technique. A post-op mechanical axis within ±3° of neutral can result in a more ROM increase after one year.

Direct epidural metastasis of breast cancer mimicking a large lumbar disc sequestrum: A case report and review of literature.

We report a case of cauda equina syndrome (CES) caused by an epidural metastasis of breast cancer, which oddly mimicked a large disc sequestrum leading to misdiagnosis. To our knowledge, it is the first report of a metastatic epidural breast cancer lesion mimicking a disc sequestrum.

Simultaneous Arthroscopic Anterior Cruciate Ligament Reconstruction Using Double Suspensory Technique and Medial Open-Wedge, High Tibial Osteotomy.

Anterior cruciate ligament reconstruction (ACLR) is generally performed regardless of knee malalignments. However, there are some indications for either staged or simultaneous ACL reconstruction and realignment procedures, such as high tibial osteotomy (HTO). Simultaneous HTO-ACL reconstruction has the apparent benefit of a single surgical procedure with a faster recovery than a staged procedure, and it produces good clinical outcomes. Several techniques have been described for simultaneous ACLR and medial open wedge HTO. The tibial tunnel preparation and graft fixation are the most challenging part of the procedure. Recent studies on comparison of fixation of tibial tunnel graft using suspensory fixation versus bioabsorbable screws have shown superior results of more bone preservation and less graft rupture. We assumed suspensory fixation on the tibial side with bone preservation might be more reliable in patients who received ACLR and open wedge HTO at the same time. Therefore, we described our technique of simultaneous open-wedge HTO and ACLR using double suspensory graft fixation.

Evaluation of rs1982073 polymorphism of transforming growth factor-ß1 in glioblastoma.

BACKGROUND: Glioblastoma (GBM) is the most common and invasive form of primary malignant brain tumors, with a survival rate of about 1 year. Transforming growth factor-ß1 (TGF-ß1) plays a very important role in tissue homeostasis and cancers. It seems that polymorphism of T29C (L10P, rs1982073, or rs1800470), which has been studied in various cancers such as breast and colon, creates the significant differences plays an important role in GBM prognosis and treatment. In this study, we evaluated the effect of T29C (rs1982073) polymorphism of TGF-ß1 gene in GBM. MATERIALS AND METHODS: This study was conducted on 100 cases of GBM including 47 paraffin-embedded brain tissue samples and 53 blood samples from another 53 GBM patients, who was under therapy, and 150 were controls. The TGF-ß rs1982073 single-nucleotide polymorphism (SNP) was identified by the NCBI and genotyping was performed by high-resolution melt (HRM) assay. Melt curves from HRM which suspected to SNP were selected and subjected to direct sequencing. Finally, the collected data were entered into the SPSS software (Version. 20) and mean ± standard deviation or n (%) was used to show the data. RESULTS: The mean age in GBM group was 51.63 ± 13.27 years. Accordingly, the two groups were matched in terms of age and gender (P > 0.05). The frequency of GG genotype was significantly higher in GBM patients. In contrast, although the frequency of AG genotype was higher in GBM group, it was not statistically significant. Furthermore, the presence of G allele was significantly more frequent than A allele in GBM patients. CONCLUSION: Findings of the present study supports that the Pro10Leu, rs1982073, or rs1800470 SNP in TGF-ß1 is found to be expressed significantly more in GBM patients as it was found in breast cancer.

Evaluation of rs1957106 Polymorphism of NF-κBI in Glioblastoma Multiforme in Isfahan, Iran.

BACKGROUND: The kB family of nuclear factor (NF-κB) is a series of transcription factors that plays a key role in regulation of immunity, cell growth, and apoptosis and is considered as the main downstream component of epidermal growth factor receptor for which there are evidence of excessive activity in most cases of glioblastoma multiform (GBM). Thus, the current information has gained evidence on NF-κBIA tumor suppressor role in GMB. SNP rs1957106 was diagnosed as a new polymorphism which affected the expression of NF-κBI and causes activation of NF-κB in GBM patients. MATERIALS AND METHODS: This study was conducted on 100 cases of GBM including 47 paraffin-embedded brain tissue samples and 53 blood samples from another 53 GBM patients and 150 controls. The NF-κBI rs1957106 SNP was identified by the NCBI, and genotyping was performed by high-resolution melt (HRM) assay. Melt curves from HRM which suspected to single-nucleotide polymorphism (SNP) were selected and subjected to direct sequencing. RESULTS: The distribution of allele A of NF-κß gene in patients with GBM with 31% was not significantly different from healthy participants (27.3%) (P = 0.375). Furthermore, the distribution of AG and GG genotypes in comparison with AA genotypes did not show a significant correlation with GBM incidence (P > 0.05). CONCLUSION: Findings of the present study provide evidence that the rs1957106 SNP in NF-κBIA is found more in GBM patients, but it was not statistically significant. As there are conflicting studies showing significant higher rate of this SNP in GBM, further study is suggested.