Quadruple Semitendinosus Graft Construct With Double Cortical Suspensory Fixation for Anterior Cruciate Ligament Reconstruction: A Biomechanical Study.

The purpose of this study was to evaluate the biomechanical properties of a graft construct with quadrupled Semitendinosus and two cortical buttons with adjustable loops concerning elongation, stiffness and resistance. A total of 15 fresh human cadaveric semitendinosus tendons were quadrupled over the two adjustable loops and stitched at the tibial tip with a cerclage type suture. They underwent pre-tensioning at 300 N for 2 minutes followed by cyclic loading (1000 cycles between 50-250 N) and finally a load-to-failure test. Statistical analysis was performed using SPSS Statistics software and groups were compared using a paired t-test, with a significance level set at α = 0.05. Graft construct elongation after pre-tensioning at 300 N was 12.8 mm (9.3 mm-16.5 mm) and mean cyclic elongation 0.4 mm (0.2 mm-0.9 mm), considered significant (p < 0,001). The resistance and stiffness values were respectively 849.46 N (649.30 N-1027.90 N) and 221.49 N (178,30 N - 276.10 N). Quadruple ST graft construct using two cortical buttons and adjustable loops showed a high stiffness and resistance with a very low elongation after cycling.

Parkinsonism induced by VNS in a child with double-cortex syndrome.

We describe a child with epilepsy associated with double-cortex syndrome in whom vagus nerve stimulation (VNS) generated parkinsonian symptoms. A 13-year-old girl presented with refractory secondary generalized epilepsy from the age of 6 years and mental retardation. Her electroencephalography (EEG) showed diffuse polyspike and wave discharges. Magnetic resonance imaging (MRI) showed double-cortex syndrome. She was submitted to extended callosal section at the age of 10 years, which yielded 50% seizure frequency reduction. She was submitted to VNS by the age of 12 years. As stimulation intensity was increased, there was appearance of extrapyramidal symptoms: She developed bilateral tremor and rigidity, and gait and postural disturbance. All symptoms disappeared 7-10 days after VNS was turned off. Several attempts to reactivate VNS led to the same results. During the periods when VNS was on she presented with marked seizure frequency reduction. This is the first report of a clinically evident direct effect of VNS on the basal ganglia.

Giant subcortical heterotopia involving the temporo-parieto-occipital region: a challenging cause of drug-resistant epilepsy.

The clinical, radiological, neurophysiological and neuropsychological findings of three patients with giant subcortical heterotopia are reported. All patients experienced psychomotor and behaviour improvement after surgery. Two subjects are seizure-free after complete excision of the heterotopia; the third patient significantly improved following subtotal removal (Engel's class II). Patients affected by giant subcortical heterotopias can have a favourable prognosis after the surgical removal of the malformation, even following long-lasting epilepsy.