A Modified "One-Stitch" Hamstring Tendon Suture Fixation Technique for Anterior Cruciate Ligament Graft Preparation.

Hamstring tendon autografts are very often used for anterior cruciate ligament (ACL) reconstruction. After harvesting of the tendons, each end is most commonly fixed with a running whipstitch suture technique, which permits adequate handling and tensioning of the graft. This conventional technique, which uses multiple locking stitches running up and down the ends of both tendons, is time consuming and carries a risk for tendon damage and needle stick injuries. As a result of the conventional whipstitch technique, suture material is left behind within the tendon inside the tibial canal, which may lead to a local inflammatory response during resorption of the sutures. This article introduces a new technique involving a modified "one-stitch" hamstring tendon suture fixation technique. (Journal of Surgical Orthopaedic Advances 28(1):74-76, 2019).

Painless swollen calf muscles of a 75-year-old patient caused by bilateral venous malformations.

A 75-year-old man presented with knee pain due to medial osteoarthritis of the knee in the orthopedic outpatient clinic. Conservative treatment was started with steroid infiltration. Besides his knee complaint reported a bilateral painless swollen calf muscle without traumatic cause, and also without any pain at night, fever or medical illness. On physical examination the soleus muscle had a swollen aspect in both calfs. The skin appeared normal without deformities and the arterial pulsations were intact. An X-ray did not show abnormalities in the tibia. Magnetic resonance imaging of the legs revealed bilateral multiple saccular intramuscular venous malformations involving the soleus muscle. Intramuscular venous malformations in skeletal muscles are rare, especially when the occurrence is bilateral. Bilateral venous malformations have the potential to be missed because of the intramuscular localization. Symptoms of intramuscular venous malformation can be often mild and overlap with non-exercise related compartment syndrome, claudication, lymphedema and post thrombotic syndrome or muscle strains.

[A case of thyreotoxic hypokalaemic periodic paralysis in a white male]. / Thyreotoxische hypokaliëmische periodieke paralyse bij een blanke man.

BACKGROUND: Thyreotoxic hypokalaemic periodic paralysis (THPP) is a rare and potentially life-threatening syndrome. It principally affects men of East-Asian origin and has rarely been described in a white person. CASE DESCRIPTION: A 34-year-old Dutch man, suffering from Graves' disease, presented with weakness in his lower limbs. Laboratory investigation showed severe hypokalaemia (1.8 mmol/l) and increased creatinine kinase levels. An electrocardiogram showed atrial fibrillation with a prolonged QTc-interval. The patient was admitted, cardiac rhythm was monitored, and he received potassium supplements. Laboratory investigation of thyroid function showed thyrotoxicosis. The patient was treated with propranolol and thiamazol. At follow-up, thyroid function, potassium levels and muscle strength had normalized. CONCLUSION: Hypokalaemia due to thyrotoxicosis should be considered in cases of unexplained paralysis. The treatment of THPP consists of treating for hyperthyroidism plus propranolol. Since the hypokalaemia is self-limiting, potassium supplementation is only necessary in cases of rhythm disturbances or cardiac-conduction disturbances. Despite adequate treatment, there is a risk of recurrence. Regular monitoring is indicated until euthyroidism is achieved.