Deltoid ligament reconstruction with autologous gracilis tendon in chronic medial ankle instability after ankle fracture surgery: A case report

IntroductionThe repair of a deltoid ligament injury, following an ankle fracture with involvement of the syndesmosis, has no univocal consensus. Also the surgical strategies in case of a subsequent chronic instability are still under debate. In this work the result of a double bundle anatomic reconstruction of deltoid ligament with ipsilateral autologous gracilis muscle tendon is presented.Case reportA 50 year old active male patient came to our attention with a catastrophic medial ankle instability, a severe pronation of the hindfoot and disabling ankle pain. He reported a Weber type B fracture of the left ankle with a lesion of the syndesmosis treated with anatomic plate and screws and a transyndesmotic screw 8 months before. The imaging showed a complete deltoid ligament lesion. Due to the impossibility of a direct repair of the ligament, we performed the reconstruction of the medial ligamentous complex with an autologous gracilis tendon graft. 10 months after the medial ligamentous complex reconstruction, the patient showed an excellent recovery of walking ability, disappearance of pain under load and resumed an active lifestyle.DiscussionThe deltoid ligament has a key role in ankle joint stability and its integrity promotes the recovery after ankle fractures. However, its lesion is often left untreated in the acute setting. The result of a chronic untreated deltoid ligament injury could be extremely disabling and the ligament reconstruction, when an optimal native deltoid ligament repair is not achievable, is the choice to restore ankle function and stability.ConclusionIn the delayed treatment of a deltoid ligament rupture the described double bundle anatomic reconstruction with autologous tendon graft can be an effective and suitable option.     

A short-term radiological and clinical comparison between the bi-cruciate and cruciate retaining total knee arthroplasty A retrospective case controlled study

PurposeThe aim of this study was to provide a short term comparison in radiological and clinical outcome between Bi-Cruciate Retaining (BCR)- and Cruciate Retaining (CR) Total Knee Arthroplasty (TKA).MethodsThe cohort consists of 122 patients undergoing a TKA with PSI, equally distributed over the BCR- and CR-TKA group. Perioperative conditions were observed and radiological images were analysed pre-, 6-weeks, and 1-year postoperative to quantify alignment differences between BCR- and CR-TKA. Preoperatively predicted templates were compared with the implanted size to determine predictive value. In addition mean range of motion and revision rates were determined in both groups.ResultsNo significant difference was observed in amount of outliers in component alignment between BCR- and CR-TKA. Outliers of the Hip-Knee-Ankle-Axis (HKA-axis) occurred significantly more frequent (P = 0.009) in the BCR-group (37.7%) compared to CR-TKA (18.0%). No clinically relevant differences regarding the predictive sizing of implant components was obtained. No significant differences were observed in revision rates (P = 1.000) and ROM (p = 0.425) between the BCR-groep and CR-group at 2-years FU.ConclusionThis study illustrates that although the HKA-axis was not fully restored, bi-cruciate retaining surgical technique for BCR-TKA is safe and effective with comparable radiological and clinical outcome as CR TKA. Randomized controlled trials with longer follow up on the HKA-axis alignment and clinical parameters are needed to confirm the presented results and should focus on possible cut off values concerning leg axis in order to define in what patients a BCR-TKA can safely be used.Level of evidence IVRetrospective Case Controlled Study.     

腹股沟脐内侧韧带滑动性疝的治疗体会(附13例报告)

目的:探讨腹股沟脐内侧韧带滑动性疝的诊断及治疗方法。方法:回顾性分析2018年1月至2020年1月收治的13例腹股沟脐内侧韧带滑动性疝患者的临床资料,患者均行腹腔镜经腹腹膜前疝修补术,观察治疗效果。结果:13例患者均成功实施腹腔镜经腹腹膜前疝修补术,手术时间36~56 min,平均(43.4±20.3)min;住院2~3 d,平均(2.5±1.2)d;术后随访8个月~2年,未损伤膀胱、精索等疝囊周围器官,术后未出现血清肿、术区慢性疼痛及复发等情况。结论:腹股沟脐内侧韧带滑动性疝只要术前仔细查体,术中细致解剖,可避免脏器损伤,但术者需具备腹腔镜疝修补的手术经验,熟悉解剖结构,术中及时作出诊断。     

The anterior versus posterior approach for the treatment of ossification of the posterior longitudinal ligament in the cervical spine: A systematic review and meta-analysis

Study Design: Systematic review and meta-analysis.Objective: To compare the effectiveness and safety between anterior and posterior approach, and determine the best surgical methods for the treatment of ossification of the posterior longitudinal ligament (OPLL) in the cervical spine.Methods: We searched the Cochrane Library, PubMed, CNKI and Wanfang Med Data databases from January 2007 to March 2018. Japanese Orthopaedic Association (JOA) scores, cervical lordosis, functional recovery rates, excellent and good outcomes of the surgical approaches, and complication and reoperation rates were analyzed. RevMan 5.3 was utilized for data analysis.Results: Eleven studies were included in the meta-analysis. By comparing the anterior and posterior approaches for the treatment of OPLL in the cervical spine, statistically significant differences were found in the preoperative initial JOA, the postoperative final JOA scores, functional recovery rates, complication rates, excellent and good outcomes of the surgical approaches and reoperation rates. However, no statistically significant difference in the occurrence of the preoperative and postoperative cervical lordosis was noted.Conclusion: The anterior approach is superior to the posterior approach in terms of the postoperative final JOA score, functional recovery rate, and clinical outcomes. Although the complication and reoperation rates of the anterior approach are higher than those of the posterior approach. We recommend the anterior approach for the treatment of OPLL when patients with occupying ratio ≥ 60%. In addition, high-quality studies with long-term follow-up and large sample size are also needed.     

牙龈成纤维细胞与牙周韧带细胞在二种玻璃离子水门汀上附着及增？…

目的 比较人类牙龈成纤维细胞（ＨＧＦ）与牙周韧带细胞（ＰＤＬＣ）在两种玻璃离子水门汀（ＧＩＣ）上的附着及增殖情况。方法 利用体外细胞培养技术及＾３Ｈ－ＴｄＲ掺入法检测ＨＧＦ及ＰＤＬＣ在两种ＧＩＣ上的附着及ＤＮＡ合成。结果 ＨＧＦ与ＰＤＬＣ在培养板上的附着及ＤＮＡ合成差异无显著性（Ｐ〉０．０５）,但ＨＧＦ在ＧＩＣ上的附着及ＤＮＡ合成明显强于ＰＤＬＣ（Ｐ〈０．０５）。结论 Ｋｅｔａｃ Ｆｉｌ和Ｆｕｊｉ