Prospective study of anterior transobturator mesh kit (Prolift?) for the management of recurrent anterior vaginal wall prolapse

Introduction and hypothesis  

Assessment of the 2-year outcome of anterior Prolift™ for women with recurrent anterior vaginal wall prolapse. This is a prospective study which was conducted in a tertiary unit in the North West of England and comprised 36 consecutive women with recurrent anterior vaginal wall prolapse.     

Outcomes of stand-alone anterior lumbar interbody fusion of L5–S1 using a novel implant with anterior plate fixation

Background ContextCompared with other approaches, anterior lumbar interbody fusion (ALIF) is believed to be more effective at restoring segmental lordosis and reducing risks of adjacent-segment disease. It remains controversial, however, whether ALIF improves global lumbar lordosis or influences pelvic parameters, possibly because of the heterogeneity of implants and levels studied.PurposeTo report clinical outcomes of stand-alone ALIF with anterior plate fixation for L5–S1 and to determine the effect on global lumbar lordosis and pelvic parameters.Study DesignThis is a retrospective case series.Patient SamplePatients that underwent isolated mini-ALIF with anterior plate fixation for L5–S1.Outcome MeasuresOswestry Disability Index (ODI), Short Form 12, lower back and legs pain on Visual Analog Scale, as well as spino-pelvic parameters.MethodsThe authors reviewed the records of all patients that underwent retroperitoneal mini-ALIF for single-level L5–S1 fusion between August 2012 and December 2016. A total of 129 patients were included, but 9 patients had incomplete preoperative radiographic data, and one patient had schizophrenia and was unable to respond to outcome questionnaires, leaving 119 patients eligible for outcome assessment. At a minimum follow-up of 1 year, seven patients refused to participate in the study or could not be reached, which left a final cohort of 112 patients.ResultsNine patients were reoperated without implant removal (four pseudarthrosis, two hematomas, one sepsis, one L4–L5 disc hernia, and one L4–L5 disc degeneration). At a mean of 20±9 months, all scores improved significantly from baseline values, with net improvement in ODI of 23.3±19.9. Multivariable analyses confirmed better postoperative ODI in patients that received 18° cages (β=−9.0, p=.017), but revealed no significant trends for net improvement in ODI. Comparison of preoperative and last follow-up radiographs revealed that global lumbar lordosis increased by 4.2±7.1° (p<.001), L5–S1 segmental lordosis increased by 11.8±6.7° (p<.001), and L4–L5 segmental lordosis decreased by 1.9±3.3° (p<.001). All pelvic parameters changed: pelvic incidence increased by 0.6±2.7° (p=.003), pelvic tilt decreased by 2.5±4.1° (p<.001) and sacral slope increased by 3.3±4.7° (p<.001).ConclusionsStand-alone mini-ALIF with anterior plate fixation for L5–S1 can change pelvic parameters while improving global and segmental lumbar lordosis. The procedure resulted in a fusion rate of 96% and comparable improvements in ODI to other studies.     

Histological comparison of after reconstruction of fate of ligamentous insertion anterior cruciate ligament： autograft vs allograft

Objective ：To analyze the histological results and the biological remodeling of ligamentous insertion after the reconstruction of anterior cruciate ligament （ ACL ） with autograft or allograft tendon. Methods： Extensor digitorum tendon was harvested from hind limb as graft material and transplanted to reconstruct the resected ACL in 12 mongrel dogs. Each free tendon end was secured by holding sutures and then the sutures were tied to the post screw at the femoral and tibial bony tunnel outlet after transplantation respectively. Autograft was randomly performed on one side of knee while allograft on the other side of knee. After transplantation, the histological analysis was undertaken at the 6th, 12th weeks and the 6th month using hematoxylineosin （HE） stain under light microscope. Results： The insertion structure of normal ACL typically consisted of four layers, i. e. , dense connective tissue, fibrocartilage, mineralized fibrocartilage and bone. There was a distinct regular tidemark line between fibrocartilage and mineralized fibrocartilage. At the 6th week postoperatively, loose connective tissue presented in the interspace between graft and bony tunnel wall in both autograft and allograft groups. At the 12th week postoperatively, the collagenons fibers between autograft and tunnel wall became well organized and the four layers of insertion with discontinuous tidemark line were demonstrated indistinctly in autograft group but not in allograft group. At the 6th month postoperatively, both of a clear and continuous tidemark line and distinct four layers could be seen in autograft group. In allograft group, only a waved discontinuous tidemark line was shown and either the anatomic morphology or the maturity of insertion was inferior to that of autograft group. Conclusions： At the 6th month postoperatively, although the ligament-eartilage insertion is primarily formed after ACL reconstruction with autograft or allograft tendon, the histological morphology and the maturation of insertion of autograft tendon are better than those of allograft group, which suggests that postoperative rehabilitation should be paid more attention and could be safer if little delayed during ACL reconstruction with allograft tendon.     

Histological comparison of fate of ligamentous insertion after reconstruction of anterior cruciate ligament: autograft vs allograft

Objective: To analyze the histological results and the biological remodeling of ligamentous insertion after the reconstruction of anterior cruciate ligament ( ACL) with autograft or allograft tendon. Methods: Extensor digitorum tendon was harvested from hind limb as graft material and transplanted to reconstruct the resected ACL in 12 mongrel dogs. Each free tendon end was secured by holding sutures and then the sutures were tied to the post screw at the femoral and tibial bony tunnel outlet after transplantation respectively. Autograft was randomly performed on one side of knee while allograft on the other side of knee. After transplantation, the histological analysis was undertaken at the 6th, 12th weeks and the 6th month using hematoxylin-eosin (HE) stain under light microscope. Results: The insertion structure of normal ACL typically consisted of four layers, i. e. , dense connective tissue, fibrocartilage, mineralized fibrocartilage and bone. There was a distinct regular tidemark line between fibrocartilage and mineralized fibrocartilage. At the 6th week postoperativcly, loose connective tissue presented in the interspace between graft and bony tunnel wall in both autograft and allograft groups. At the 12th week postoperatively, the collagenous fibers between autograft and tunnel wall became well organized and the four layers of insertion with discontinuous tidemark line were demonstrated indistinctly in autograft group but not in allograft group. At the 6th month postoperatively, both of a clear and continuous tidemark line and distinct four layers could be seen in autograft group. In allograft group, only a waved discontinuous tidemark line was shown and either the anatomic morphology or the maturity of insertion was inferior to that of autograft group. Conclusions: At the 6th month postoperatively, although the ligament-cartilage insertion is primarily formed after ACL reconstruction with autograft or allograft tendon, the histological morphology and the maturation of insertion of autograft tendon are better than those of allograft group, which suggests that postoperative rehabilitation should be paid more attention and could be safer if little delayed during ACL reconstruction with allograft tendon.     

The in vivo model of cross－species rabbit anterior eye chamber of human endometrium

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Giant cell tumor of rib – rare location on the anterior aspect

Giant cell tumor rarely occurs in ribs, where it presents posteriorly. We present a report of a giant cell tumor of bone occurring anteriorly in the rib with a review of the literature. Received: 26 January 1999     

Investigating the effects of anterior tibial translation on anterior knee force in the porcine model: Is the porcine knee ACL dependent?

This study sought to determine anterior force in the porcine knee during simulated 6‐degree‐of‐freedom (DOF) motion to establish the role of the anterior cruciate ligament (ACL). Using a 6‐DOF robot, a simulated ovine motion was applied to porcine hind limbs while recording the corresponding forces. Since the porcine knee is more lax than the ovine knee, anterior tibial translations were superimposed on the simulated motion in 2 mm increments from 0 mm to 10 mm to find a condition that would load the ACL. Increments through 8 mm increased anterior knee force, while the 10 mm increment decreased the force. Beyond 4 mm, anterior force increases were non‐linear and less than the increases at 2 and 4 mm, which may indicate early structural damage. At 4 mm, the average anterior force was 76.9 ± 10.6 N (mean ± SEM; p < 0.025). The ACL was the primary restraint, accounting for 80–125% of anterior force throughout the range of motion. These results demonstrate the ACL dependence of the porcine knee for the simulated motion, suggesting this model as a candidate for studying ACL function. With reproducible testing conditions that challenge the ACL, this model could be used in developing and screening possible reconstruction strategies. © 2010 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 29:641–646, 2011     

Is anterior genital tract trauma associated with complaints of postpartum urinary incontinence?

We evaluated whether anterior genital trauma is associated with urinary incontinence after vaginal birth. A prospective cohort of midwifery patients consented to mapping of trauma at birth and assessment of continence postpartum. Trauma was categorized into intact, anterior (periuretheral, clitoral, labial), perineal or both. Incontinence was defined as a positive response to the question, “Since the birth of your baby, have you leaked urine when you did not mean to?” and social impact assessed by the Incontinence Impact Questionnaire-7 (IIQ-7). Of 554 eligible women, 436 (79%) provided incontinence data 3 months postpartum. Genital trauma was common, occurring in 80% of women: in 148 (34%) trauma was anterior, 119 (27%) had both anterior and perineal trauma and 80(18%) had only perineal trauma. Since delivery, 27% (118/436) women leaked urine. Fewer had IIQ-7 scores greater than 0, at 55/436 (12%). Women with anterior trauma, 29/148 (20%), were less likely to complain of incontinence than all others, 89/288 (31%) (P?=?0.01). Urinary incontinence is common after giving birth, although most women have mild symptoms. Anterior trauma is not associated with increased complaints of urinary incontinence.     

Does the choice of suture material matter in anterior and posterior colporrhaphy?

Introduction and hypothesis

The optimal suture material in traditional prolapse surgery is still controversial. Our aim was to investigate the effect of using sutures with rapid (RA) or slow (SA) absorption, on symptomatic recurrence after anterior and posterior colporrhaphy.

Methods

A population-based longitudinal cohort study with data from the Swedish National Quality Register for Gynecological Surgery. A total of 1,107 women who underwent primary anterior colporrhaphy and 577 women who underwent primary posterior colporrhaphy between September 2012 and September 2013 were included. Two groups in each cohort were created based on which suture material was used. Pre- and postoperative prolapse-related symptoms and patient satisfaction were assessed.

Results

We found a significantly lower rate of symptomatic recurrence 1 year after anterior colporrhaphy in the SA suture group compared with the RA suture group, 50 out of 230 (22 %) vs 152 out of 501 (30 %), odds ratio 1.6 (CI 1.1–2.3; p?=?0.01). The SA group also had a significantly higher patient satisfaction rate, 83 % vs 75 %, odds ratio 1.6 (CI 1.04–2.4), (p?=?0.03). Urgency improved significantly more in the RA suture group (p?<?0.001). In the posterior colporrhaphy cohort there was no significant difference between the suture materials.

Conclusions

This study indicates that the use of slowly absorbable sutures decreases the odds of having a symptomatic recurrence after an anterior colporrhaphy compared with the use of rapidly absorbable sutures. However, the use of RA sutures may result in less urgency 1 year postoperatively. In posterior colporrhaphy the choice of suture material does not affect postoperative symptoms.

     

Minimally invasive plate osteosynthesis using anterior–inferior plating of clavicular midshaft fractures

Introduction  

This study evaluated the clinical and radiological outcomes of acute displaced clavicular midshaft fractures treated with minimally invasive plate osteosynthesis (MIPO).     

Thorascopically guided therapy of the “anterior column”. Technique and results

Anterior thoracoscopic interbody stabilization and fusion was performed in 163 patients. Lesions treated were located between T4 and L3, most frequently occurring at T12/ L2. Operative time decreased dramatically as experience was gained with the procedure. 2 patients early in the series successfully were converted to an open procedure. One positioning related pressure harm on the thoracodorsal nerve and one irritation of the L1 root at the entrance site were both transitory. Postoperative control by X-ray and CTscan showed correct positioning of the bone graft, as well as the fixation device in all patients. Our experience with this minimally invasive procedure demonstrated the feasibility of the method. Major advantages compared to the open procedure are reduced morbidity of the approach, postoperative pain reduction, early recovery of function and shortened hospital stay.     

A follow-up study of arthroscopic combined reconstruction of anterior and posterior cruciate ligaments with allograft patellar tendon

Objective： To evaluate the therapeutic effect of combined reconstruction of anterior cruciate ligament （ ACL ） and posterior cruciate ligament （ PCL ） simultaneously by using allograft patellar tendon under arthroscopy. Methods： From May 2003 to November 2005, 10 cases of ruptured ACL and PCL were fixated with compressed screws and reconstructed under arthroscopy with allograft patellar tendon simultaneously. The clinical results were evaluated according to IKDC, Lysholm, and Tegner clinical rating scales. Results. All patients were followed up for 12-30 months （mean： 18 months ）. At the last follow-up, there was no knee extension limitation and knee flexion was between 120° and 135°, with an average of 128.38°. The Lysholm score of the 10 cases was 66. 5 ± 5. 6 before operation and 89.8 ± 3.4 at last follow up. The difference was statistically significant （ P 〈 0.01 ）. The average Tegner activity score decreased from 6.9 ± 1.7 （ range ： 4-9 ） before injury to 5.5 ± 1. 6 （rang： 2-9） at the follow-up （P=0.53）. At the end of follow-up, IKDC score was graded as A in 4 cases （40.0 % ）, B in 5 （50.0 % ）, and C in 1 （10.0%）. Of the 10 patients, 8 returned to the same sports level as before injury and 2 were under the level. Conclusion. Arthroscopic combined reconstruction of ACL and PCL with allograft patellar tendon has the advantages of minimal trauma in surgery and reliable satisfactory outcome.     

Expression of estrogen receptor-α and -β in anterior vaginal walls of genuine stress incontinent women

Our objective was to study the expression of estrogen receptor (ER) isoforms, ER- and ER-, in the anterior vaginal wall of menopausal and fertile women with genuine stress incontinence (SI) by immunohistochemistry and Western blot analysis. Eighteen menopausal women with SI who either were or were not taking estrogen/progestin replacement therapy and 14 fertile women with SI who either were or were not taking contraceptives were enrolled in the study. Biopsies from the suburethral anterior vaginal wall were obtained at tension-free vaginal tape (TVT) operation. Monoclonal antibody to ER- and polyclonal antibody to ER- were used to stain frozen sections of vaginal tissue. The receptor expressions were scored based on percentage of positive cells. ER- was detected in vaginal epithelial, stromal and smooth muscle cells. In menopausal SI women ER- was detected significantly more frequently in the vaginal walls of estrogen/progestin-treated patients than in those who were untreated. Fertile SI women had significantly higher expression of ER- than menopausal SI women. ER- was not observed in vaginal blood vessels. ER- was detected in epithelial and vascular smooth muscle cells of the vagina. No significant difference in ER- expression was observed between different groups of patients. The expression of ER- was not correlated with that of ER-. Both ER- and - were detected, indicating a potential role for both types of estrogen receptor in the human vaginal wall. The expression of ER-, but not of ER-, in menopausal SI women was regulated by estrogen/progestin replacement therapy. The presence of ER- in vaginal vascular smooth muscle cells raises the possibility of vascular effects of estrogen on the human vaginal wall.Abbreviations ER Estrogen receptor - SI Stress incontinence - TVT Tension-free vaginal tape - HRT Hormone replacement therapy - ABC Avidin–biotin–peroxidase complex - PBS Phosphate buffered saline - DAB DiaminobenzidineEditorial Comment: This was an interesting study in that it addressed the expression of estrogen receptors in incontinent women. There is not a control group of incontinent women. Conclusions regarding mechanisms of action or treatment with estrogen for incontinence cannot be made on the basis of the results. At best this study proves there is expression of estrogen receptors in vaginal tissues, which has been done by prior investigators.     

Correction of kyphotic deformity before and after transection of the anterior longitudinal ligament – a cadaver study

With a custom-made measuring unit, two separate experiments, involving six and five cadaveric torsos with intact rib cages and sternums, respectively, were carried out to determine the effect of the transection of the anterior longitudinal ligament with and without osteodiscectomy and its influence on the thoracic kyphosis. The open or thoracoscopically assisted anterior release, as part of the operative treatment of scoliosis or kyphosis, usually consists of a transection of the anterior longitudinal ligament (ALL) and an additional discectomy. A complete osteodiscectomy, however, is not always possible with a minimally invasive approach. As part of our biomechanical research, we attempted to quantify the amount of correction achievable with a defined force prior to and following the isolated transection of the anterior longitudinal ligament. The aim of the study was to clarify whether or not an isolated transection of the anterior longitudinal ligament is sufficient to obtain an adequate anterior release of the spine. In the surgical treatment of kyphotic deformities, anterior release of the spine is performed in the form of a transection of the ALL and discectomy. Recently, video-assisted thoracic surgery has become increasingly popular in spine surgery. As part of this change in surgical technique, the question has arisen as to what extent an isolated transection of the ALL provides an adequate release of the thoracic spine. Eleven human spines were retrieved from fresh cadavers, dissected, and attached to a specially constructed apparatus. The spine was attached to the construct at the twelfth vertebral body. C6 and C7 were fixed in synthetic resin. We installed the instruments in such a manner as to reproducibly apply a torsional moment of 10 Nm to the spine. Motion was only permitted in the sagittal plane. Segmental transections of the ALL were carried out from T3 to T7. For comparison, the sagittal Cobb angle was also documented following an anterior release combined with an osteodiscectomy. With the isolated transection of the ALL, an average correction of the sagittal Cobb angle of 4° in each functional spinal motion segment was recorded. In comparison, the additional osteodiscectomy led to a further average increase of only 2° per level. The measurements performed on human cadavers showed that the isolated transection of the ALL leads to a sufficient anterior release of the thoracic spine, allowing a correction of the kyphotic deformity. The release with a concomitant osteodiscectomy represents a more time-consuming and more invasive procedure resulting in only a slightly greater amelioration of the sagittal Cobb angle, while being associated with a greater patient morbidity. Received: 29 February 2000