Preoperative Clinical Evaluation Research Articles

Treatment strategies for cervical spondylotic myelopathy-is laminectomy alone a safe and effective option?

Cervical laminectomy may be underutilized in the treatment of cervical spondylotic myelopathy (CSM) due to concerns regarding potential for post-operative instability and/or kyphosis. The purpose of this retrospective, observational study is to assess the short-term clinical and radiological outcomes as well as complications associated with a group of carefully selected patients who underwent laminectomy alone for CSM and compared them to a cohort of patients who underwent laminectomy with fusion. Patients with CSM were identified via review of a single surgeon's cases. All patients underwent preoperative clinical evaluation, lateral flexion-extension cervical radiographs, and documentation of neck and/or extremity pain via Nurick Scale and modified Japanese Orthopedic Association (JOA) scores. Postoperative follow-up occurred at 1, 3 and 6 months for all patients. Statistical analysis was performed via Student's t-test for parametric values and Wilcoxon (Mann-Whitney) rank sum test for ordinal scores. Multi-variable linear regression was used to correct for co-variance. Forty-one patients who underwent laminectomy alone and 13 patients who underwent laminectomy with fusion were identified who met inclusion criteria. Both groups demonstrated significant improvement on Nurick and JOA scores postoperatively. Two patients in the laminectomy alone group required a subsequent one-level anterior cervical discectomy and fusion for onset of postoperative neck pain, without neurological symptoms or new deficits in the follow up period. There was no difference in rates of post-operative kyphosis between the groups. In appropriately selected patients without pre-operative kyphosis or abnormal motion on flexion-extension films, cervical laminectomy remains a safe and effective treatment option.

Extent of posterolateral tibial plateau impaction fracture correlates with anterolateral complex injury and has an impact on functional outcome after ACL reconstruction

PurposeThe impact of posterolateral tibial plateau impaction fractures (TPIF) on posttraumatic knee stability in the setting of primary anterior cruciate ligament (ACL) tear is unknown. The main objective was to determine whether increased bone loss of the posterolateral tibial plateau is associated with residual rotational instability and impaired functional outcome after ACL reconstruction.MethodsA cohort was identified in a prospective enrolled study of patients suffering acute ACL injury who underwent preoperative standard radiographic diagnostics and clinical evaluation. Patients were included when scheduled for isolated single-bundle hamstring autograft ACL reconstruction. Exclusion criteria were concurrent anterolateral complex (ALC) reconstruction (anterolateral tenodesis), previous surgery or symptoms in the affected knee, partial ACL tear, multi-ligament injury with an indication for additional surgical intervention, and extensive cartilage wear. On MRI, bony (TPIF, tibial plateau, and femoral condyle morphology) and ligament status (ALC, concomitant collateral ligament, and meniscus injuries) were assessed by a musculoskeletal radiologist. Clinical evaluation consisted of KT-1000, pivot-shift, and Lachman testing, as well as Tegner activity and IKDC scores.ResultsFifty-eight patients were included with a minimum follow-up of 12 months. TPIF was identified in 85% of ACL injuries (n = 49). The ALC was found to be injured in 31 of 58 (53.4%) cases. Pearson analysis showed a positive correlation between TPIF and the degree of concomitant ALC injury (p < 0.001). Multiple regression analysis revealed an increased association of high-grade TPIF with increased lateral tibial convexity (p = 0.010). The high-grade TPIF group showed worse postoperative Tegner scores 12 months postoperatively (p = 0.035).ConclusionHigher degrees of TPIFs are suggestive of a combined ACL/ALC injury. Moreover, patients with increased posterolateral tibial plateau bone loss showed lower Tegner activity scores 12 months after ACL reconstruction.Level of evidenceIII.

Outcomes of tracheal resection and anastomosis for post intubation tracheal stenosis: a study of 12 cases

Post intubation tracheal stenosis is a severe clinical condition with an increasing prevalence due to the advances of critical care medicine. This is a retrospective study including 12 cases of post-intubation tracheal stenosis managed by TRA in our head and neck surgery department between the years 2013 and 2019. All patients underwent preoperative clinical evaluation based on neck CT scan and endoscopy under general anaesthesia. Traffic road accidents and trauma were the main causes of prolonged intubation. Ten (10) patients required tracheostomy. According to the Cotton Meyer grading, 4 patients had grade II, 2 had grade III and 4 had grade IV. The mean length of stenosis was 16.2±5.6 millimeters. T-tube was inserted intraoperatively in 5 patients. 4 were successfully decannulated in a mean delay of 9.2 months. Early postoperative complications were subcutaneous emphysema, laryngeal edema, aspiration pneumonia, intra-tracheal migration of the T-tube, and vocal cord paralysis each complication occurred in 1 case. Late postoperative complications were granulation tissue formation observed in 5 cases and restenosis in 3 cases. The initial success rate of the TRA was 91.7%. Management of Post intubation tracheal stenosis requires a skillful multidisciplinary team. TRA guided by a meticulous preoperative evaluation is the gold standard. Keywords: tracheal resection, anastomosis, tracheal resection with end-to-end anastomosis, cervical computed tomography

Hysterectomies: An Audit at A Tertiary Care Public Sector Hospital in Lahore, Pakistan

Background: Hysterectomy is a common gynecological surgery worldwide. Thorough preoperative clinical and radiological assessment of the patients followed by histopathological evaluation of the specimens is mandatory for providing good health care services to the patients. Objective: The objective of the study was to analyze the spectrum of histopathological findings in hysterectomy specimens &amp; correlate them with their clinical &amp; radiological findings. Patients and Methods: This was a retrospective, descriptive, cross sectional study, carried out at the Pathology Department of Fatima Jinnah Medical University, Lahore. All the gynecological hysterectomies received at the department from 1st December 2018 to 30th November 2020 were included in the study. Data collected, included age of the patient, clinical presentation, radiological findings, type of hysterectomy performed and complete histopathology report of the specimen. Data was analyzed using SPSS version 17. Results: A total of 637 hysterectomy specimens were included in the study. The age of the patients ranged from 22 years to 80 years with a mean age of 46 ± 9 years. The commonest clinical indication was a uterine mass (47.7%). Most frequent preoperative radiological (USG/ CT scan/MRI) finding was uterine mass/polyps (52%). The commonest surgical procedure was total abdominal hysterectomy (52.4%). On histopathological evaluation, 99% of the cases showed chronic cervicitis. The commonest diagnosis in the uterine corpus was leiomyoma. Uterine malignancy accounted for 7.3% of the cases and 4.7% of hysterectomies were done for ovarian malignancies. Practical implicationThis study aims to highlight the need for a multi-disciplinary audit for all hysterectomy cases to reduce the incidence of this surgery &amp; for better patient care &amp; management. Conclusion: Hysterectomy is a major, invasive surgical procedure. A vigilant preoperative clinical and radiological evaluation of the patient can reduce the incidence of this surgery. Histopathological analysis of all hysterectomy specimens is mandatory for diagnosis of benign and malignant conditions, recognition of precancerous lesions and detection of incidental findings. Keywords: Hysterectomies, Audit, Leiomyoma, preoperative radiological evaluation, histopathological evaluation

Application of neuronavigation system in intracranial meningioma surgery: a retrospective analysis of 75 cases.

Neuronavigation is an extremely common and useful system in intracranial surgeries. It is used to determine the pre-operative incision, perform the most appropriate craniotomy, and provide intraoperative guidance. However, its use in meningioma surgery is controversial, and there is a dilemma whether it is necessary. This study was performed to determine the effect of neuronavigation in meningioma surgery. Information related to pre-operative clinical evaluation and use of neuronavigation, neuroimaging, intraoperative tumor and surgical related information, and post-operative outcomes of 75 consecutive patients with meningiomas between January 2015 and 2020 were retrospectively collected. The values between groups were statistically compared. There were no significant differences in pre-operative patient and tumor characteristics between the groups. In cases using neuronavigation, the mean operative time, craniotomy size, and blood loss during tumor resection were significantly lower, and post-operative hospital stay was shorter in these patients (p < 0.05). However, there were no differences in post-operative complications and clinical outcomes. The use of neuronavigation in meningioma surgery reduces blood loss during surgery, reduces the surgical time, and shortens the post-operative hospital stay. Thus, we conclude that the neuronavigation system is useful in meningioma surgery.

A Study of Preoperative Predictors of Difficult Laparoscopic Cholecystectomy

Introduction : Laparoscopic cholecystectomy is the most commonly performed surgery for various gallbladder disorders nowadays. Difficulty during laparoscopic cholecystectomy is being faced by many surgeons. If the difficulties are detected preoperatively, management can be planed accordingly by the surgeon. In this study, preoperative clinical and radiological evaluation of patient were studied to predict the difficulties during laparoscopic cholecystectomy. Materials and Methods: All patients who are undergoing laparoscopic cholecystectomy are evaluated by their Name, Age, Sex, BMI, clinically palpable gallbladder, ultrasound findings are correlated with the preoperative score for the prediction of difficulty during laparoscopic cholecystectomy in this study. Results: Upon analyzing of risk factors with pre operative risk score, there was a significant association with BMI, palpable gallbladder, GB wall thickness, impacted gall stones and peri cholecystic collection. Conclusion: This study combined the preoperative clinical and radiological parameters for better prediction of difficult Laparoscopic Cholecystectomy. It provides a base for further studies to validate in this aspect, and it also aids in formulating an efficient scoring system for prediction of difficult Laparoscopic Cholecystectomy and reducing the incidence of complications.

Articulating spacers in elderly patients affected by periprosthetic knee infection: clinical findings and outcome.

Although the two-stage technique is a validated strategy in periprosthetic joint infections, there is a lack of data on the patients' clinical outcomes after the spacer placement. This study aims at evaluating the quality of life, joint function, and pain in patients over 70 years affected by periprosthetic joint infection treated with a two-stage exchange using metal on polyethylene spacers. We conducted a follow-up study to evaluate the quality of life and functionality of consecutive patients over 70 years treated for PJI at our institution using a validated assessment set including the Western Ontario and Mac Master University (WOMAC) score, Knee Society Score (KSS), numerical rating scale (NRS). Knee Range of Movement (ROM) before and after the surgery was also analyzed. Forty-five patients with a mean age of 76 ± 5.3 years were included. Coagulase-negative staphylococci were the most isolated microorganisms. In the preoperative study group, the WOMAC score was 48.4 ± 18.9, and the KSS objective and functional scores were 37.6 ± 17.3 and 27.6 ± 22.3, respectively. NRS was 7.3 ± 1.8. After three months of follow-up, we found better results than preoperative clinical evaluation. We retrieved similar results comparing our post-operative PROMS (WOMAC and KSS scores) with published thresholds for treatment success two months after primary total knee arthroplasty. The infection eradication rate was 87%. The two-stage technique confirmed its efficacy in the treatment of PJI. Patients over 70 years who had undergone the first stage of the two-stage technique for PJI showed a good quality of life and knee function.

Involutional ectropion: etiological factors and therapeutic management.

Involutional Ectropion is commonly prevalent disorder of eyelid malposition caused by age-related degeneration of the periocular tissues. This study conducted to provide a summary and review of surgical practice for the management of lower eyelid involutional ectropion and enlist various causative factors that explain the pathogenesis. The review of literature on risk factors and surgical approaches for involutional lower eyelid ectropion, searched on PubMed from 1980 onwards. Multiple factors contribute to horizontal and vertical lower eyelid involutional ectropion. Several surgical practices have been described over the last years to address these factors. Lateral tarsal strip is the most used and effective surgery to treat horizontal laxity. Knowledge of various contributing factors and surgical procedures will enable to design the most effective therapeutic management for lower eyelid involutional ectropion. surgical approaches are individualized depending on preoperative clinical evaluation of possible causative factors and concerning the predominant location of the ectropion will result in a high success rate.

Would augmentation genioplasty using patient-specific PEEK (Polyether Ether Ketone) implant meet patient’s expectations?

Introduction: Patient-specific implants become very valuable in restoring facial contours, including the chin area. Evaluation of patient satisfaction with the esthetic results should be a primary concern. Aim of study: To evaluate the success of augmentation genioplasty using patient-specific PEEK (Polyether Ether Ketone) implant in meeting patient’s expectations. Methods: Seven patients were enrolled in this study. They were all having deficient chin that was managed by augmentation genioplasty using patient-specific PEEK implant. Preoperative clinical evaluation was performed for all patients. With the help of MIMICS and 3-MATIC soft wares, diagnosis, virtual planning and final implant design were done. Finally, STL file was sent for milling using PEEK material. Under GA, PSI was inserted through an intra-oral vestibular approach and fixed to the underlying bone using mini-screws. Patient expectations were evaluated by Face-Q questionnaire. Result: The study was conducted on 7 cases, 3(42.9%) of which were males and 4(57.1%) were females. The mean age of the cases was (22.00±1.29) years. All patients showed high degree of contentment with the procedure. Conclusions: Patient-specific PEEK implant can be used for chin augmentation with good esthetic results close to that of patients’ expectations.

Quality of Pre-operative Assessment for Mid Urethral Slings in Women Who Present With Mesh Complications

ObjectiveTo study quality of pre- and post-operative evaluation in women undergoing mid-urethral synthetic sling surgery who subsequently have complications. Materials and methodsStudy inclusion was chart availability for preoperative clinical history, examination, urodynamics and/or post-operative visit in women with mesh complications 2014-2021 in a tertiary practice. The primary outcome was compliance with quality indicators and guidelines for preoperative and post-operative clinical evaluation and urodynamics. Results122 women had preoperative, 102 urodynamic reports and 108 post-operative charts available for review. Only clinical history and examination showed moderate compliance (71% nature, 57% severity, 87% exam) with quality indicators, all other quality indicators were low. including documentation of counselling of mesh risks (11%) and risks of incontinence surgery (17%) . Compliance with guidelines (optimal care) was also low (bladder diary 61%, all others ≤41%). Post-operative evaluation did not comprehensively screen for complication e.g., flow rate/post-void residual performed in 9%. A significant proportion had an early adverse symptom (55%) or intervention e.g. trimming of exposure (40%) ConclusionCompliance with quality indicators and guidelines was generally low for pre-operative evaluation and urodynamic testing. There was inadequate content and length of post-operative evaluation despite a significant proportion presenting with adverse symptoms at first postoperative follow-up. Future research could target these areas for development of tools to improve compliance and education of health providers.

Results of arthroscopic rotator cuff repairs in patients with comorbid disability of other extremities

Objectives: We hypothesized that arthroscopic rotator cuff repair improves functional and clinical outcomes in the patients with comorbid disability in the extremities. Materials and Methods: In a retrospective study, data were collected for eleven patients (six males and five females) from a tertiary care hospital from 2010 to 2018. All the patients underwent arthroscopic rotator cuff repair after confirmed clinical and radiological diagnosis. All the patients were operated on by a single surgeon. UCLS scores and ultrasound imaging were used for pre-operative and post-operative clinical and radiological evaluation, respectively. The mean follow-up was of 3 years. Statistical analysis was carried out using SPSS software and statistical significance was considered at P &lt; 0.05. Results: Out of 11 patients, seven patients had massive cuff tears, two patients had medium cuff tears, and two patients had small cuff tears. Out of 11 patients, three patients were contralateral side amputees, four patients were wheelchair-bound due to post-poliomyelitis muscle weakness, one patient had opposite side hand amputation, and three patients had same side hemiplegia secondary to cerebrovascular stroke. The dominant side was involved in eight patients and the non-dominant side was involved in three patients. Functional range of motion, the visual analog scale for pain, and satisfaction and UCLS scores improved significantly after arthroscopic cuff repairs. Ultrasound evaluation after a mean of 14 ± 3 months revealed complete healing in 88% of cases and partial healing in 12% of cases. Conclusion: Arthroscopic rotator cuff repair improves functional and clinical outcomes in patients with comorbid disability in the extremities. Careful and meticulous clinical acumen, surgical planning, technique, and post-operative rehabilitation program are important for excellent outcomes in arthroscopic cuff repairs, especially in these functionally high-demanding patients.

CLINICAL ANATOMY AND VARIATION OF PROFUNDA FEMORIS ARTERY- CASE SERIES

Background:The profundafemoris artery (PFA) or deep femoral artery is a large branch that arises posterolaterally from femoral artery (FA) distal to the inguinal ligament. Primary source for the blood supply of the head of the femur is the mainly by the deep branch of profundafemoris artery (Medial circumflex artery). In the indication and choice of profundaplasty, vascular reconstructive procedure, the knowledge of the anatomy of PF may be particularly important for the clinicians dealing with them. Objectives: The study aimed at study of origin and branching pattern of PF, b. Correlation with surgical aspect of PF. Material &amp; Methods: The present study was conducted in 10 formalin-fixed lower limbs from the Department of Anatomy, Shri AtalBihari Vajpayee Medical college&amp; RI, Bangalore&amp; Bangalore Medical college &amp; Research Institute. Dissection of PFA and its branches were carried out &amp; the following parameters were observed and photographed. Results: Origin of PF was posterolateral in 6cases , posterior in 3, &amp; lateral in 1 to FA. Origin of MCFA was from PFA in 9cases &amp; FA in 1. The mean distance of origin of MCFA was 1.8 cm (range 0.1-8.5 cm). Origin of LCFA was from PFA in 9 cases &amp; FA in 1. The mean distance of origin of LCFA was 2.3 cm (range 0.3-7 cm) Conclusion: Knowledge of PFA is very important for surgeons to prevent iatrogenic injury as well as during profundoplasty as it is sole artery to supply majority of thigh region. Knowledge of variations in profundafemoris and its branches helps surgeons during preoperative clinical evaluation for surgical and interventional revascularization of the ileo-femoral and femoro-popliteal segments, in open canulation of femoral artery for cardiopulmonary bypasss, in radiological interventions for A-V malformations, and in salvage operations for traumatic limb ischemia.

The effect of the number of anchors used in the medial row on clinical outcomes in arthroscopic double row repair of rotator cuff tears: retrospective evaluation of patients with 3 to 7 years of follow-up

Aim: Arthroscopic double row (DR) suture anchor repair is one of the most frequently applied methods in the surgical treatment of rotator cuff tear (RCT). Various modifications have been tried to eliminate some of the disadvantages of this technique such as operation time, high cost, and the high risk of retearing. In this study, we aimed to investigate whether placing a single or double suture anchor in the medial row affects clinical and functional outcomes and retear rates in patients with RCT who were operated with the DR suture anchor technique.&#x0D; Material and Method: A retrospective study including 58 patients aged 18-65 years who underwent DR suture anchor repair due to medium-sized RCT and had a minimum follow-up period of 3 years was conducted. One knotless anchor was placed in the lateral row in all patients. In the medial row, we placed 1 all suture anchor (ASA) in group 1 and 2 ASAs in group 2. Visual pain scale (VAS), University of California Los Angeles Score (UCLA), American shoulder and elbow score (ASES) scales were used for preoperative and postoperative clinical and functional evaluation, and complications and retears were recorded.&#x0D; Results: When the preoperative and postoperative VAS, UCLA and ASES scores were compared within groups, there were significant difference from pre- to post-operative findings in both groups (p 0.05). Operation time in Group 1 was significantly shorter than in Group 2 (p

Outcome after resection arthroplasty or shortening oblique osteotomy of the lesser metatarsals combined with arthrodesis of the first metatarsophalangeal joint for severe rheumatoid forefoot deformities.

We investigated objective and patient-reported outcomes after resection arthroplasty or shortening oblique osteotomy (SOO) of the lesser metatarsals combined with arthrodesis of the first metatarsophalangeal (MTP) joint for severe rheumatoid forefoot deformities. 17 feet from 14 women (mean age, 67.8years) underwent resection arthroplasty of the lesser metatarsal heads (MTH resection group), while 13 feet from nine women and two men (mean age, 68.7years) underwent SOO of the lesser metatarsals (MTH preservation group). Arthrodesis of the first MTP joint was performed in all cases. Mean follow-up in the MTH resection and preservation groups was 25.0 and 21.3months, respectively. Preoperative and postoperative clinical evaluation included Japanese Society for Surgery of the Foot (JSSF) scale and self-administered foot evaluation questionnaire (SAFE-Q) scores. Mean total JSSF scale significantly improved from 53.4 to 76.4 in the MTH resection group (p < .001) and from 50.1 to 74.2 in the MTH preservation group (p = .002). Pain and pain-related and shoe-related SAFE-Q subscale scores significantly improved after surgery in both groups. In the MTH resection group, recurrence of painful callosities and claw toe deformity was observed in four and three feet, respectively. In the MTH preservation group, one patient experienced recurrence of painful callosities and one underwent revision surgery for IP joint dislocation. Resection arthroplasty or SOO of the lesser metatarsals combined with arthrodesis of the first MTP joint achieved significant improvement with respect to pain relief, deformity correction, and footwear comfort.

Surgical Treatment of Substernal Goiter Part 1: Surgical Indications, Pre-Operative, and Peroperative Preparation.

Surgery is one of the most appropriate treatment options for many patients with substernal goiter (SG). However, SG surgery has some technical difficulties and a higher risk of complications compared to normal cervical thyroid surgery. Due to these technical difficulties and complication risks, which we also mentioned in our study, SG surgery should be performed by experienced and high-volume endocrine surgeons in centers with a large team and technical equipment. Pre-operative clinical and radiological evaluation and definitions in SG were evaluated in detail in our previous study. Detailed pre-operative evaluation, pre-operative risk assessment, surgical anatomy, anesthesia, appropriate surgical planning and estimation of surgical width are extremely important in SG surgery, where surgical technical difficulties and increased complication risks compared to cervical thyroid surgery come to the fore. In this study, we aimed to evaluate these preoperative and peroperative preparations in detail.

Satisfactory clinical and radiologic outcomes with a new shorter and modular stem for end-stage hip osteoarthritis: an international prospective multicentre pilot study.

Introduction: This multicenter prospective cohort study aimed to assess the safety and clinical and radiologic performance of the CLS® BreviusTM Stem with Kinectiv® Technology. Material and Methods: A total of 222 consecutive subjects, recruited in five different centers, qualifying for primary total hip arthroplasty (THA), were enrolled in the study. All the subjects received the CLS® BreviusTM Stem with Kinectiv® Technology. All the enrolled study subjects underwent pre-operative clinical and radiographic evaluation. Additionally, all subjects underwent post-operative clinical, functional and radiographic evaluations at 6 months and 1, 2, 3, and 5 years. These evaluations included implant survival, pain and functional performance (Harris Hip Score [HHS], University of California, Los Angeles [UCLA] Activity Score, Oxford Hip Score), subject quality-of-life (EQ-5D), radiographic parameters, complications, and concentration of metal ions (aluminum and titanium) in blood. Results: No revisions were performed during the follow-up period. Of the 222 patients, only 76 completed the 5-year follow-up. Only 7 and 5 patients had aluminum and titanium 5-year evaluations, respectively. All the clinical parameters showed an overall improvement in the overtime measured with ANOVA for repeated measures; furthermore, the clinical scores showed a statistically significant improvement at 5 years with respect to pre-operative value (p < 0.001). Aluminum and titanium showed no variation for repeated measures at different time points (p > 0.05). A total of six complications were reported, of which only two were hip-related. Conclusions: The function of the CLS® BreviusTM Stem with Kinectiv® Technology indicated that subject well-being significantly increased following THA regardless of age, gender, BMI, previous surgery, primary diagnosis, and lifestyle.

ТРУДНОСТИ ДИАГНОСТИКИ И ЛЕЧЕНИЯ ПОВРЕЖДЕНИЙ ДВЕНАДЦАТИПЕРСТНОЙ КИШКИ У ДЕТЕЙ

Objective: To study the clinical presentations and diagnosis of injuries to the duodenum in children. Methods: The study analyses the diagnosis and treatment of duodenal injuries in 14 children admitted to pediatric surgery departments at the Bashkir State Medical University, Ufa, Russia and Saint-Petersburg State Pediatric Medical University, Russia, between 2000 and 2020. The clinical presentations of duodenal injuries, diagnostic challenges and preoperative and intraoperative errors were evaluated. Results: High diagnostic error rates were observed since practitioners have a knowledge gap regarding the clinical presentation and surgical treatment principles of duodenal trauma among affected children. The authors believe that the presence of one of the symptoms (retroperitoneal hematoma, emphysema, yellowish green staining of the retroperitoneum and tissues is an indication for inspection of the retroperitoneal part of the duodenum, performed according to Kocher manoeuvre. Conclusion: Damage to the duodenum in children presents considerable difficulties in diagnosis and treatment. In this regard, imaging studies should be employed for diagnosis. Diagnostic laparoscopy is considered the gold standard for preoperative clinical evaluation. Retroperitoneal hematoma and/or emphysema, and yellow-green staining of the retroperitoneum and tissues, are indications for inspection of the retroperitoneal part of the duodenum, performed according to Kocher manoeuvre. Keywords: Duodenum, trauma, diagnosis, surgical treatment.

Computed tomographic evaluation of bone tunnel enlargement following single bundle anterior cruciate ligament reconstruction with hamstring autograft

&lt;p class="abstract"&gt;The purpose of this study is to evaluate tibial and femoral tunnel diameter following single bundle anterior cruciate ligament (ACL) reconstruction and correlation between tunnel enlargement and clinical outcome. Twelve patients who underwent primary arthroscopic single bundle ACL reconstruction with hamstring graft were included in prospective case series. Preoperative clinical evaluation was performed using international knee documentation committee (IKDC) subjective score and grade, Tegner knee score and Lysholm knee score. Computed tomography (CT) evaluation of the femoral and tibial tunnels were done on post-operative day (POD) 1 and at a mean follow up of 9 months (range 7-12 months) and were compared with functional scores. Our study shows significant tibial and femoral tunnel enlargement on CT scan at 9 months (range 7-12 months) postoperatively. All the clinical evaluation scales showed improvement postoperatively. The mean average femoral tunnel diameter increased significantly (p&amp;lt;0.001) from 8.17±0.57 to 9.08±0.660 (10%) and tibial tunnel diameter increased significantly (p&amp;lt;0.001) from 8.08±0.669 to 9.07±0.601 (11%) postoperatively at a mean follow up of 9 months (range 7-12 months). No statistically significant difference between tunnel enlargement and clinical values were found. In our current prospective CT based study, we conclude use of extracortical fixation of femoral tunnel with stronger fixation of the tibial tunnel, tunnel orientation and anatomic fixation close to the joint line along with less aggressive rehabilitation protocol with use of extension knee brace may result in minimization of tunnel widening with quadrupled hamstring autograft.&lt;/p&gt;

Foramen Magnum Meningioma-The Attainment of the Intra-Arachnoidal Dissection: 2-Dimensional Operative Video.

Ventral foramen magnum meningiomas are a forbidding lesion. The stake is so high with a risk of devastating paralysis and respiratory failure. Careful preoperative clinical and radiological evaluation is necessary to implement the best treatment plan. Successful surgical intervention depends on paying high attention to minute details throughout the case, from intratracheal intubation to extubation. The neural head-on-neck position is critical to avoid further medullary compression at intubation and positioning.1 Extensive neurophysiological monitoring, including somatosensory, motor, brainstem evoked potential, and cranial nerves, during the positioning and throughout the case, is extremely helpful to detect early signs of dysfunction.1 To expose and access ventral tumors, partial condyle resection and vertebral artery transposition are invaluable techniques.2,3 Preservation and minute manipulation of the vital neurovascular structures at this junction that includes the medullar, anterior spinal artery, posterior inferior cerebellar artery, vertebral junction perforators, and lower cranial nerves are essential for good outcomes. This is achieved by microsurgical intra-arachnoidal dissection under high magnification and after debulking the tumor to establish that plane.1,3,4 The demonstration of this technique is the purpose of this article. We demonstrate these surgical tenets applied to the resection of a large ventral foramen magnum meningioma extending from the midclivus to the C3 vertebral body level in a 54-yr-old female presenting with swallowing difficulties. The patient consented to the surgical intervention and the publication of her images. Image at 1:38 reprinted with permission from Al-Mefty O, Operative Atlas of Meningiomas. Vol 1, © LWW, 1998.

Complications of Surgical Treatment of Adult Scoliosis

Introduction: With the increase in global life expectancy, the number of patients presenting with progressive spinal deformities is also on rise. The increasing frequency of surgical intervention as a treatment of this group of patients is associated with many complications and also with increasing rate of reoperation.&#x0D; Methodology: Seventy-two cases of adult scoliosis were treated surgically in Ain Shams spine unit with a minimum follow-up of five years (average, 76 months). Preoperative clinical and radiological evaluation was done, with special emphasis on the degree of pains (back and leg), Oswestry Disability Index (ODI), scoliosis angle, lumbar lordosis, any instability, and the level of spinal canal stenosis needing decompression. The pelvic incidence was measured preoperatively to plan the amount of lordosis needed to be restored.&#x0D; Result: The mean preoperative scoliosis angle was 22 ± 10.4º (16 to 34º) and the mean preoperative lordosis angle was 20.3 ± 12.7º (–15 to –28º). The mean preoperative ODI score was 54.7 ± 5.5, and the mean postoperative scoliosis angle improved to 7.4 ± 3.3. The mean postoperative lordosis angle became 37.3 ± 8.6, and the mean postoperative ODI score was 21.3 ± 3.8.&#x0D; Conclusion: The list of complications included seven cases of pseudoarthrosis and screw loosening, adjacent segment fracture in nine cases, and one case of spondylodiscitis at a level just proximal to the fused level. These 17 cases needed reoperations (24%). Additionally, there were five cases of dural tear, prolonged graft side pain in one case, and two cases of superficial wound infections.