Lateral Suture Research Articles

Does the anatomy around the pterygomaxillary suture contribute to the risk of bad fractures in Le Fort I osteotomy?

Le Fort I (LF1) osteotomy, a common orthognathic procedure for the maxilla aimed at achieving maxillary mobility by separating the pterygomaxillary suture, poses a risk of bad fracture that may lead to complications and inadequate mobility. Our study analyzed two- and three-dimensional computed tomography images to identify the anatomical factors associated with bad fractures due to an LF1 osteotomy.Point ‘a’ is where the lateral pterygomaxillary suture on the axial image aligns with the zygomatic alveolar line near the line used for an LF1 osteotomy, with the base line connecting the bilateral ‘a’ points.Two risk factors were identified on the pterygoid side: (i) when the distance from point ‘a’ to the intersection of the base line and the medial pterygoid plate was <6.0 mm; and (ii) when the distance from the piriform aperture margin to the base line was <44.78 mm. Six risk factors were identified on the maxillary side, including the distance between the most anterior and most lateral points of the internal surface of the maxillary sinus being <31.9 mm. Our analyses revealed that fractures that occur during pterygomaxillary suture separation in an LF1 osteotomy are influenced by anatomical factors of the maxilla and pterygoid process, which form the pterygomaxillary suture.

Autospreader Flaps in Closed Rhinoplasty: Our Technique and Long-Term Results.

Rhinoplasty is a common and complex surgical procedure. Respiratory and aesthetic dissatisfaction are major causes of revision surgeries. Multiple techniques were described to reconstruct the middle nasal vault and improve functional outcomes. One of these techniques is the use of autospreader flaps. These flaps were constantly modified by different surgeons. In our practice, we use a modified technique of autospreader flaps in closed rhinoplasty. Neither upper lateral cartilage scoring nor suture fixation to the septum wasdone. We conducted a retrospective study on 183 patients, analyzing revision rates and long-term functional results using the NOSE scale. Data analysis was done using IBM Corp. Released 2019. IBM SPSS Statistics for Windows, Version 26.0. Armonk, NY: IBM Corp. Long-term results showed satisfactory aesthetic outcomes with low revision rates (13.6%). Concerning the NOSE score, it was completed by 87 of the 183 patients, yielding a response rate of 47.5%. A mean NOSE score of 18.1 +/- 21.1 at 4.4 years of follow-up was obtained. Autospreader flaps offer simplicity, reproducibility, and effectiveness in closed rhinoplasty. It representsa valuable option for selected patients, especially in populations with high dorsal reduction surgery demand.

Ex vivo biomechanical investigations of combined extra- and intracapsular stabilization in canines with cranial cruciate ligament deficiency.

Intracapsular reconstruction (ICR) has long been recommended as a treatment for cranial cruciate ligament deficiency (CCLD) in dogs, but it has fallen out of favor due to its inferior long-term functional outcomes. These outcomes may be attributed to the poor stiffness and strength of the graft in the early period before ligamentization is completed. Additional placement of extracapsular sutures to mechanically protect the graft during the ligamentization process may be a viable method to address this problem. However, the biomechanical effect of this combined surgical approach remains unknown. This study aimed to evaluate the 3D kinematics of the CCLD stifle in dogs in response to ICR and combined extra- and intracapsular reconstruction (CEICR). Twelve hindlimbs were collected from nine cadavers of mature dogs. The limbs were tested using a custom-made testing apparatus that reproduces their sagittal plane kinematics during the stance phase. Four statuses of stifle joints were tested, namely, (a) cranial cruciate ligament (CCL) intact; (b) CCLD; (c) CCLD stifle stabilized by CEICR; and (d) CCLD stifle stabilized by ICR only. Three-dimensional stifle kinematics at the 5 instances of the stance phase were measured with an optoelectronic system. The results showed that ICR marginally corrects the increased adduction, internal rotation, and caudodistal stifle joint center displacement that occur as a result of CCLD. CEICR led to better restoration of the stifle kinematics, especially with respect to the internal rotation and cranial translation stabilities. Furthermore, CEICR only resulted in minor excessive restraints on other motion components. The findings indicated that the additional lateral fabellotibial suture offers immediate stability to the stifle, consequently lowering the risk of graft over-elongation in the short term postoperatively. Considering the propensity for the extracapsular suture to degrade over time, further in vivo studies are warranted to explore the long-term effects of the CEICR procedure.

Ex vivo biomechanical evaluation and comparison of lateral femoro-fabella ligament suture and lateral suture with bone anchor for cranial cruciate ligament repair in cats.

To compare the biomechanical properties of lateral femoro-fabella ligament suture (FFLS) and lateral suture with a bone anchor suture (BAS) for management of feline cranial cruciate ligament disease. 12 femurs from 6 mature cat cadavers. The samples were collected from April to June 2023. The specimens had an FFLS and, subsequently, BAS placed and were positioned into a biomechanical testing machine, preloaded from 5 N to 15 N for 100 cycles, and subsequently, a load to suture failure was applied. The displacement at 5 N and 15 N, the total precycle displacement (millimeters), the force at 3 mm displacement and at failure (newtons), the displacement at failure (millimeters), and the stiffness to failure (Newton:millimiter) were recorded. Nonparametric Wilcoxon signed-rank tests were used to compare data between the 2 groups. The displacement at 5 N and 15 N and the total precycle displacement were significantly higher in the FFLS group compared to the BAS group. Additionally, the FFLS group results showed less consistent displacement and marked variability. The force (newtons) at 3 mm displacement was higher in the BAS group. There was no significant difference in force and no significant difference in displacement at failure between the 2 groups. However, the stiffness to failure (N/mm) was significantly higher in the BAS group. BAS represented a more stable and reliable femur attachment for extracapsular suture in cats. To demonstrate the stability and reliability between BAS and FFLS and influence implant selection in the treatment of cranial cruciate ligament rupture in cats with evaluation of biomechanical properties.

A remarkable fossil berothoid larva (Neuroptera) from the late Eocene Rovno amber (Ukraine)

ABSTRACT The larva of Berothidae or Rhachiberothidae (Neuroptera) is described from the late Eocene Rovno amber; it is the first record of either family from this amber. The larva is in particular characteristic with a four-segmented antenna, at least five stemmata, and lateral sutures on the head capsule connecting the coronal suture and lateral margins of the head. Based on these characters, the larva probably may belong to one of basal taxa of Berothidae, possibly to a suprageneric taxon which includes an undescribed small species from Baltic amber which is closely related to the mid-Cretaceous Haploberotha, or to Rhachiberothidae. This larva was most likely free living, possibly occurring under/on tree bark. In addition, the genus Protomenocria Emeljanov and Shcherbakov 2009 (Hemiptera: Achilidae) is recorded from Rovno amber for the first time.

Association of Periprosthetic Fibula Fracture With Knotless Suture Button (TightRope) Fixation for Ankle Syndesmosis in Elite Athletes

Background: Suture button fixation is frequently used to stabilize the distal tibiofibular syndesmosis in athletes sustaining an isolated ligamentous syndesmosis injury. Purpose: To report on a series of periprosthetic fibula fractures adjacent to the lateral suture button after a subsequent unrelated ankle injury or progressive stress injury after initial ankle syndesmosis stabilization using the knotless TightRope (Arthrex). Study Design: Case series; Level of evidence, 4. Methods: Eight elite athletes with periprosthetic fibula fractures and stress injuries around the lateral suture buttons were evaluated. In all athletes, the knotless TightRope had been used to stabilize an isolated ligamentous ankle syndesmotic injury, after which all patients recovered and returned to professional sports at their preinjury level. The athletes subsequently developed an acute fibula fracture or a fibula stress fracture related to the 3.7-mm drill hole in the fibula adjacent to the lateral suture buttons after a mean of 14.1 months (range, 5-29 months). The management of these complications was analyzed. Results: Five athletes sustained a periprosthetic fibula fracture in the form of undisplaced spiral Weber B injuries after a subsequent, unrelated injury. Poor healing response was noted with initial nonoperative treatment for the first 2 athletes, and surgical intervention was performed with successful union of the fracture and return to sports. The subsequent 3 athletes had early surgery with uneventful recovery. Another 3 athletes developed stress injuries adjacent to the fibula suture button without a history of acute trauma. In 2 of the 3 athletes, the position of lateral suture buttons was in the anterior third of the fibula. Initial nonoperative management yielded poor healing response, and subsequent surgical intervention was required to enable healing and return to sports. Conclusion: Nonoperative management of fractures adjacent to the fibula suture button of a knotless TightRope may lead to a delay in union. Therefore, early surgical intervention should be considered in elite athletes, whose return-to-sports time is critical. Care is needed to ensure that the fibula hole for the suture button is centrally located because the eccentric placement of the fibula hole in the anterior third of the fibula may contribute to the development of a stress reaction or stress fracture. Surgical intervention for a periprosthetic fibula stress fracture leads to satisfactory resolution of symptoms.

Melatonin promotes osteogenesis of bone marrow mesenchymal stem cells by improving the inflammatory state in ovariectomized rats

To investigate the effects of melatonin (MT) on bone mass and serum inflammatory factors in rats received ovariectomy (OVX) and to investigate the effects of MT on the levels of inflammatory factors in culture medium and osteogenic ability of bone marrow mesenchymal stem cells (BMSCs) stimulated by lipopolysaccharide. Fifteen 12-week-old Sprague Dawley (SD) rats were randomly divided into 3 groups. The rats in Sham group only received bilateral lateral abdominal incision and suture, the rats in OVX group received bilateral OVX, and the rats in OVX+MT group received 100 mg/(kg·d) MT oral intervention after bilateral OVX. After 8 weeks, the levels of serum inflammatory factors [interleukin-1β (IL-1β), IL-6, and tumor necrosis factor α (TNF-α)] were detected using ELISA assay. Besides, the distal femurs were detected by Micro-CT to observe changes in bone mass and microstructure, and quantitatively measured bone volume fraction, trabecular thickness, and trabecular number. The BMSCs were extracted from the femurs of three 3-week-old SD rats using whole bone marrow culture method and passaged. The 3rd-5th passage BMSCs were cultured with different concentrations of MT (0, 1, 10, 100, 1 000 µmol/L), and the cell viability was then detected using cell counting kit 8 (CCK-8) to select the optimal concentration of MT for subsequent experiments. Cells were devided into osteogenic induction group (group A) and osteogenic induction+1/5/10 μg/mL lipopolysaccharide group (group B-D). The levels of inflammatory factors (IL-1β, IL-6 and TNF-α) in cell culture medium were detected using ELISA assay after corresponding intervention. According to the results of CCK-8 method and ELISA detection, the cells were intervened with the most significant concentration of lipopolysaccharide for stimulating inflammation and the optimal concentration of MT with osteogenic induction, defining as group E, and the cell culture medium was collected to detect the levels of inflammatory factors by ELISA assay. After that, alkaline phosphatase (ALP) staining and alizarin red staining were performed respectively in groups A, D, and E, and the expression levels of osteogenic related genes [collagen type Ⅰ alpha 1 chain (Col1a1) and RUNX family transcription factor 2 (Runx2)] were also detected by real time fluorescence quantitative PCR (RT-qPCR). ELISA and Micro-CT assays showed that compared with Sham group, the bone mass of the rats in the OVX group significantly decreased, and the expression levels of serum inflammatory factors (IL-1β, IL-6, and TNF-α) in OVX group significantly increased (P<0.05). Significantly, the above indicators in OVX+MT group were all improved (P<0.05). Rat BMSCs were successfully extracted, and CCK-8 assay showed that 100 µmol/L was the maximum concentration of MT that did not cause a decrease in cell viability, and it was used in subsequent experiments. ELISA assays showed that compared with group A, the expression levels of inflammatory factors (IL-1β, IL-6, and TNF-α) in the cell culture medium of groups B-D were significantly increased after lipopolysaccharide stimulation (P<0.05), and in a concentration-dependent manner. Moreover, the expression levels of inflammatory factors in group D were significantly higher than those in groups B and C (P<0.05). After MT intervention, the expression levels of inflammatory factors in group E were significantly lower than those in group D (P<0.05). ALP staining, alizarin red staining, and RT-qPCR assays showed that compared with group A, the percentage of positive area of ALP and alizarin red and the relative mRNA expressions of Col1a1 and Runx2 in group D significantly decreased, while the above indicators in group E significantly improved after MT intervention (P<0.05). MT may affect the bone mass of postmenopausal osteoporosis by reducing inflammation in rats; MT can reduce the inflammation of BMSCs stimulated by lipopolysaccharide and weaken its inhibition of osteogenic differentiation of BMSCs.

The Posteromedial-Transseptal Portal for Arthroscopic Suture Hook Repair of Posterior Horn Tears and Popliteomeniscal Fascicles Tears of the Lateral Meniscus

We present a convenient and safe arthroscopic technique for suturing the lateral meniscus. In this technique, the clinician establishes a conventional posteromedial approach in the figure-of-four position of the knee by using the anterolateral and anteromedial observation approaches. Behind the posterior cruciate ligament, an operational approach is formed through the posterior mediastinum of the knee joint. Through this approach, suture hook can be brought to the posterior horn and body of the lateral meniscus, thus simplifying the suture of the lateral meniscus. We have used this technique to finish all-inside suture using suture hooks in a variety of types of lateral meniscal injuries, including longitudinal posterior horn tears, bucket handle meniscus tears, and tears around the popliteal hiatus area. Compared with traditional lateral meniscal all-inside suture technology through anteromedial or anterolateral approaches, this technology can suture more accurately, safely, and conveniently, avoid the involvement of the popliteal tendon suture, and the lower risk of complications such as popliteal vascular and nerve injury occur.

Long-term outcome in dogs with cranial cruciate ligament disease evaluated using the canine orthopaedic index.

Cranial cruciate ligament disease (CCLD) is common in dogs, but studies on the long-term treatment outcome are scarce. The long-term outcome in a cohort of 71 dogs with CCLD treated with tibial plateau levelling osteotomy (TPLO, n = 18), tibial tuberosity advancement (TTA, n = 23) or lateral fabellotibial suture (LFS, n = 30) was evaluated using the canine orthopaedic index. The risk of stiffness and lameness was increased in dogs treated with TPLO (stiffness: incidence rate ratio [IRR] 1.33, p = 0.015; lameness: IRR 1.34, p = 0.020) or TTA (stiffness: IRR 1.26, p = 0.035; lameness: IRR 1.31, p = 0.026) when compared to LFS at a median follow-up time of 4.6 years. No follow-up veterinary examination was performed. Data were collected from only two university animal hospitals, and thus, a referral bias towards more complicated cases is possible, which may limit the generalisability of the results. Clinicians can use the results to inform dog owners about the expected long-term outcome in dogs with CCLD.

True aneurysms of the inferior phrenic arteries in celiac trunk compression syndrome and surgical treatment of three patients

The Objective was to pay attention to the rare combination of a true aneurysm of the inferior phrenic artery and the syndrome of compression of the celiac trunk, its open decompression and elimination of aneurysms in three patients.Methods and Materials. From September 2018 to December 2022, in 5 patients with celiac trunk compression syndrome (three men; mean age 49.4 years, from 18 to 72 years) out of 182, according to MSCT angiography and during surgery, an aneurysm of the right inferior phrenic artery was detected in two and left for three. These arteries originated from the post-stenotic moderately dilated part of the celiac trunk.Results. On average, its diameter at the site of stenosis was 1.9 mm and the degree was 58 %, the trunk was 8.6 mm and the aneurysm was 6.8 mm, and its length was 8 mm. In 4 cases, the aneurysm originated from the ostium of this artery and in one case, 5 mm from it, without involvement of the celiac trunk. All 5 aneurysms were concentric sac-shaped, including a funnel-shaped variant in two of them. Three out of 5 patients successfully underwent open decompression of the celiac trunk and immediately resection of the aneurysm in two with the imposition of a lateral suture and ligatures on the artery, respectively, and exclusion in one with a purse-string suture.Conclusion. An aneurysm of the inferior phrenic artery originating from the celiac trunk may be one of the specific manifestations of its long-term significant diaphragmatic compression. With such a combination of lesions, the expediency of decompressing the celiac trunk and removing the aneurysm from the bloodstream, regardless of its size, should be considered.

Physical activity measured with an accelerometer in dogs following extracapsular stabilisation to treat cranial cruciate ligament rupture.

To quantify the physical activity levels in dogs with cranial cruciate ligament rupture before and after lateral fabellar suture stabilisation surgery. Seventeen dogs (mean weight, 12.3±5.1 kg) with unilateral cranial cruciate ligament rupture were fitted with an accelerometer for seven consecutive days at four different time points: before surgery (T0), one (T1), three (T3) and six(T6) months after surgery. The total activity and times spent in sedentary activity, light to moderate activity and vigorous activity were recorded by the accelerometer, and preoperative and postoperative data were compared. At all time points, dogs underwent clinical evaluations (lameness score, stifle pain score and thigh circumference) and their owners were asked to respond to questionnaires to subjectively score the physical activity and quality of life of the dogs. At the four time points, the dogs spent between 21.2 and 21.4 hours on sedentary behaviour, 2.3 and 2.5 hours performing light to moderate activity, and 13 to 15 minutes performing vigorous activity. There was no increase in physical activity variables or decrease in sedentary behaviour over time. Lameness scores, pain score and dogs' quality of life improved significantly during the postoperative period. At T6, 17 (100%) of 17 dogs presented no lameness, 16 (94%) of 17 dogs presented no stifle pain, 16 (94%) of 17 owners rated the quality of life as very good and excellent, and 16 (100%) of 16 owners reported a total return to normal activity levels. The clinical recovery after extracapsular stabilisation of the stifle joint was not associated with a spontaneous increase in physical activity or a decrease in sedentary behaviour.

In canine cranial cruciate ligament disease, are conservative treatment and lateral fabellotibial suture recoveries comparable?

PICO question In dogs with cranial cruciate ligament disease, is conservative non-surgical treatment as effective as surgical treatment with the lateral fabellotibial suture technique in reducing time to recovery? Clinical bottom line Category of research Treatment. Number and type of study designs reviewed One retrospective study. Strength of evidence Zero. Outcomes reported There is no evidence that surgical treatment with the lateral fabellotibial suture (LFTS) reduces time to recovery compared to conservative treatment in dogs with cranial cruciate ligament disease. Conclusion In dogs with cranial cruciate ligament disease there is no statistical evidence to support recommendation of surgical treatment with the LFTS technique compared to conservative treatment in reducing time to recovery. How to apply this evidence in practice The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources. Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.

Primary Unilateral Cleft Lip Rhinoplasty Technique: The Melbourne Technique.

Addressing the primary nasal deformity associated with congenital cleft lip is a complex problem that ranges in severity. There are both esthetic and functional ramifications that develop over time. This paper serves to describe the novel Melbourne technique in addressing the primary cleft nasal deformity through repositioning the septal cartilage to the facial midline, reconstructing the nasal floor, and an upper lateral suture to suspend and overcorrect the lower lateral cartilage by modifying the McComb technique. The definitive aim is long-term symmetry in the correction of the cleft lip nasal deformity and these techniques have demonstrated improved nasal symmetry in our unilateral cleft patients.

Fusion of Lateral Calvarial Sutures on Volume-Rendered Computed Tomography Reconstructions in Patients With Known Craniosynostosis.

After treating a child with familial sagittal craniosynostosis, clinocephaly, and bilateral parietomastoid/posterior squamosal suture fusion, the authors wondered if major-suture synostosis and clinocephaly were associated with abnormal fusion of minor lateral calvarial sutures. The authors reviewed all preoperative volume-rendered head computed tomography reconstructions performed for craniosynostosis at their institution from 2010 through 2014 and determined whether the sphenoparietal, squamosal, and parietomastoid sutures were open, partially fused, or fused. The authors determined whether any sutures were abnormally fused based upon a previous study from their center, in which abnormal fusion was defined as either 1 of 3 abnormal fusion patterns or abnormally-early fusion. The authors then determined the rate of abnormal fusion of these sutures and whether abnormal fusion was associated with (1) major-suture craniosynostosis, (2) type of craniosynostosis (sutures involved; single-suture versus multisuture; syndromic versus nonsyndromic), and (3) clinocephaly. In 97 included children, minor lateral sutures were abnormally fused in 8, or 8.2%, which was significantly higher than in children without craniosynostosis from our earlier study. Abnormal minor lateral suture fusion was not associated with the type of single-suture synostosis or with multisuture synostosis but was associated with syndromic synostosis. Four of 8 children with abnormal minor lateral suture fusion had multisuture synostosis and 6 had syndromic synostosis. Lateral sutures were abnormally fused in 1 of 4 subjects with clinocephaly, which was not significant. Abnormal minor lateral calvarial suture fusion is significantly associated with major-suture craniosynostosis, especially syndromic synostosis.

Comparison of perioperative serum osteocrin concentrations between surgical techniques in dogs with cranial cruciate ligament rupture

The cranial cruciate ligament (CCL) rupture is a common orthopedic disease in dogs that is usually managed with tibial plateau leveling osteotomy (TPLO) or extracapsular lateral suture (ECLS). Osteotomy is generally associated with some complications, including nonunion. The periosteum plays an important role in bone growth and remodeling. Osteocrin (OSTN), which was recently identified and is involved in bone formation and differentiation, is produced in the periosteum and osteoblasts. The aimed to investigate whether the concentrations of serum OSTN change before and after stifle surgery in dogs and compare the OSTN concentrations in the two surgical techniques (TPLO: n = 20 vs. ECLS: n = 36). The postoperative serum OSTN concentration in the TPLO group was significantly lower than the preoperative value (p < 0.05), while serum OSTN concentrations differed statistically between the preoperative and suture-removal periods. In contrast, no significant differences were observed in the ECLS group. In conclusion, osteotomy affects serum OSTN concentrations during the perioperative period in dogs, which may be related to periosteal injury.

Facial masculinization surgery

Facial masculinization surgery

Evaluating the construct validity of UroLift simulator through a virtual learning experience of urology residents

Simulations are useful and can mirror the situations needed for skills development. They can have significant impacts on patient safety and help physicians gain proficiency in complex procedures with a short learning curve. They have been validated as an assessment tool and can utilize innovative machines or platforms. Here, we evaluate the construct validity and the performance of residents with different levels using UroLift (NeoTract) simulation. This was a prospective observational study. Two groups of trainees were distributed according to their training level: junior residents and senior residents. Each had to finish three cases of varying difficulties. The data were first tested with the Shapiro-Wilk normality test. Construct validity used an independent sample t-test; P < 0.05 was considered significant. Significant differences were seen in performance among junior residents and senior residents in the following skills: proximal centering, mucosal abrasion, and implants in proximal zones. However, insignificant results were seen for number of deployments, successful deployments, lateral suture centering, and implants in the distal zones. UroLift simulations are useful for training as a practicing tool. Nevertheless, objective performance evaluation using UroLift simulations requires further steps and frameworks as a source of validity before further result interpretation.

CASE REPORT: SQUAMOUS SUTURE SYNOSTOSIS IN RAINE SYNDROME CASE REPORT AND LITERATURE REVIEW

The purpose of this case study review is to evaluate Squamous Suture synostosis in Raine syndrome. Raine syndrome is characterized by dysmorphic features including exophthalmos, microcephaly, gum hypertrophy, low-set ears, midface hypoplasia, and osteosclerosis. RS is closely associated with squamous suture synostosis, one of the lateral minor skull sutures separating the parietal and squamous temporal bones. The study examined a three-year-old Saudi male born to healthy parents and a known case of Raine syndrome, craniosynostosis, degenerative myopia, and cataract. The Computed tomography (CT) scan results showed that the patient had metopic craniosynostosis with squamosal suture craniosynostosis and high intracranial pressure (ICP). The findings show that the association between Squamous Suture synostosis and Raine syndrome is seen in osteoporosis-related to deficiency of carbonic anhydrase II. However, in Raine syndrome disorder, the calcifications are seen after one year of age in many cases. Thus, it can be noted that Raine syndrome is inherited as an autosomal recessive in FAM20C mutation and is most identified among children.

Knot location in arthroscopic inside-out meniscal repair: Cadaveric evaluation

BackgroundThe inside-out repair technique is the gold standard for treatment of meniscal tears, while some soft tissues can be hung as the sutures are tied outside the capsule. The purpose was to clarify the association between the suture site and knot location in the arthroscopic inside-out technique. MethodsInside-out meniscal suture was arthroscopically performed on medial and lateral menisci in twenty-three cadaveric knees, on the assumption that longitudinal tear existed. A retractor was inserted above the semi-membranous tendon and anterior to the gastrocnemius for the medial side, while the retractor was placed in the anterior space of the gastrocnemius for the lateral side. After identifying three segments (anterior, middle and posterior segments), eight sutures were inserted into the following eight areas in each knee: anterior (M1, L1) and posterior (M2, L2) areas of the middle segment, and anterior (M3, L3) and posterior (M4, L4) areas of the posterior segment. Twelve knees underwent meniscal repair on femoral side and eleven passed sutures on the tibial side, while knots were tied outside of the joint. Attentive dissection was performed to assess the relation between knot locations and the principal structures around the knee joint. ResultsIn medial meniscal suture, most sutures for the middle portion (M1, 2) bound medial collateral ligament (MCL), while a few cases included the semi-membranous tendon for the M4 area. In lateral meniscal suture, sutures for the L1 area tied some fibers of lateral collateral ligament (LCL) in high frequency, while popliteal muscles/tendons were tied over at the L3 area. ConclusionsMost suture knots were located on MCL or capsule in medial meniscus suture, while more than half sutures passed through LCL or popliteal tendon/muscle in lateral meniscus suture. An assistant should retract LCL under direct observation and the surgeon must confirm the direction of needle for lateral meniscal repair.

Merged Lateral Row Modification of the Suture Bridge Technique for Simultaneous Supraspinatus and Subscapularis Repair

Concomitate supraspinatus and subscapularis tear is not rare, and the suture bridge technique is one of the most effective methods for rotator cuff repair. However, some limitations exist in the use of such a technique for simultaneous supraspinatus and subscapularis repair. We introduce the technique of a merged lateral row for suture bridge rotator cuff repair, in which the lateral suture of the supraspinatus and subscapularis is placed in the greater tuberosity. We believe that this technique can reduce both the duration and cost of surgery and decrease soft-tissue damage. It can also allow the “comma tissue,” to be simultaneously repaired.