Broad ligament hematoma is typically seen during cesarean section due to rupture of branches of uterine and vaginal vessels and it’s rare to be seen post-normal vaginal delivery. Addressing puerperal hematomas postpa...Broad ligament hematoma is typically seen during cesarean section due to rupture of branches of uterine and vaginal vessels and it’s rare to be seen post-normal vaginal delivery. Addressing puerperal hematomas postpartum presents considerable challenges for obstetric care providers. While hematomas such as those affecting the vulva, vulvovaginal region, or paravaginal area are frequently encountered, retroperitoneal hematomas are rare and notably pose a greater risk to the life of the patient. The medical literature contains scant case reports on retroperitoneal hematomas, with no consensus on a definitive treatment approach. Pelvic arterial embolization has emerged as both a sensible and increasingly preferred method for treating these hematomas recently, but its application is contingent upon the patient maintaining hemodynamic stability and the availability of a specialized interventional embolization unit. In our case, we are presenting a very rare case of a 31-year-old primigravida female with a history of in vitro fertilization pregnancy. She delivered a normal vaginal delivery at 31 weeks gestation. Unfortunately, she experienced multiple complications intrapartum, including preeclampsia and placental abruption. These complications increased her risk of developing a broad ligament hematoma.展开更多
Symptomatic cyclops lesions are complications that can be seen at rates of up to approximately 10%after anterior cruciate ligament reconstruction.However,recurrent cyclops lesions have rarely been documented.There are...Symptomatic cyclops lesions are complications that can be seen at rates of up to approximately 10%after anterior cruciate ligament reconstruction.However,recurrent cyclops lesions have rarely been documented.There are case rare series in the literature regarding the treatment of recurrent cyclops lesion.Future large studies are needed to investigate factors contributing to the development of cyclops lesions and syndrome and treatment options.展开更多
Introduction: Acromioclavicular (AC) joint dislocation is a common shoulder injury, comprising 9% - 12% of shoulder girdle injuries. Optimal management remains challenging, with treatment decisions guided by the Rockw...Introduction: Acromioclavicular (AC) joint dislocation is a common shoulder injury, comprising 9% - 12% of shoulder girdle injuries. Optimal management remains challenging, with treatment decisions guided by the Rockwood classification system. Controversies surround grade III injuries, necessitating further classification. Non-operative treatment has shown favorable outcomes, while surgical interventions vary. Anatomical coracoclavicular reconstruction (ACCR) has demonstrated biomechanical advantages over traditional methods. Arthroscopic techniques offer advantages, minimizing deltoid detachment and allowing concurrent pathology identification. This study evaluates the outcomes of arthroscopic-assisted ACCR in chronic AC joint dislocation. Surgical Technique: Arthroscopic-assisted ACCR involves meticulous portal placement, tendon graft harvesting, diagnostic arthroscopy, and coracoid exposure. The clavicle tunnels were made to mimic the conoid and trapezoid ligament positions, using FibreTape#2 loop and Dog Bone Button for correct placement against the coracoid base, and passing the semitendinosus graft through to reconstruct the conoid ligament, reduction done and graft follow through for anatomical reconstruction. Methods: A retrospective cohort study at Hospital Kuala Lumpur analyzed 35 patients undergoing arthroscopic-assisted ACCR for Rockwood grade III - V AC joint dislocations. Inclusion criteria encompassed trauma ≥ 3 weeks prior, no prior shoulder injuries, and ≥12-month follow-up. Functional and radiological assessments utilized ASES scores and coracoclavicular distances, respectively. Statistical analysis employed descriptive statistics and logistic regression. Results: The mean age was 38.9 years (SD 11.26), and 34 of 35 patients were male. Grade IV injuries were predominant (37.1%). Waiting time for surgery averaged 234.9 days. Functional improvement was substantial postoperatively (ASES: 55.5 to 88.9). Radiological outcomes demonstrated reduced coracoclavicular distances and maintained reduction. No significant correlation was observed between injury grade and outcomes. Conclusion: Arthroscopic-assisted ACCR for chronic AC joint dislocation yields significant functional and radiological improvement, irrespective of injury grade. Waiting time for surgery exhibits minor impact on outcomes, emphasizing the procedure’s efficacy. Concomitant injuries do not impede success, highlighting the versatility of this approach in managing shoulder instability. The study contributes valuable insights into the nuanced management of chronic AC joint dislocations and supports the adoption of arthroscopic-assisted ACCR as a viable treatment option.展开更多
BACKGROUND Many studies have focused on the femoral tunnel technique and fixation method,but few studies have involved the tibial tunnel technique and fixation method.The all-inside technique is one of the new techniq...BACKGROUND Many studies have focused on the femoral tunnel technique and fixation method,but few studies have involved the tibial tunnel technique and fixation method.The all-inside technique is one of the new techniques that has been described in recent years.All-inside anterior cruciate ligament(ACL)reconstruction is based on a tibial socket instead of a full tunnel.This method has many potential advantages.AIM To compare clinical outcomes of knee ACL autograft reconstruction using allinside quadrupled semitendinosus(AIST)and traditional hamstring tendon(TBT)techniques.METHODS From January 2017 to October 2019,the clinical data of 80 patients with ACL reconstruction were retrospectively analyzed,including 67 males and 13 females.The patients had an average age of 24.3±3.1 years(age range:18-33 years).The AIST technique was used in 42 patients and the TBT technique was used in 38 patients.The time between operation and injury,operative duration,postoperative visual analogue scale(VAS)score and knee functional recovery were recorded and compared between the two groups.The International Knee Documentation Committee(IKDC)and Lysholm scoring system were used to comprehensively evaluate clinical efficacy.RESULTS Eighty patients were followed for 24-36 mo,with an average follow-up duration of 27.5±1.8 mo.There were no significant differences in the time between surgery and injury,operative duration,IKDC and Lysholm scores of the affected knee at the last follow-up evaluation between the two groups.There were significant differences in VAS scores 1 d,3 d,7 d,2 wk and 1 mo after surgery(P<0.05).There was no significant difference in VAS score at 3 mo,6 mo and 1 year after operation.CONCLUSION The efficacy of the AIST ACL reconstruction technique was comparable to the TBT technique,but the postoperative pain was less with the AIST technique.Thus,the AIST technique is an ideal treatment choice for ACL reconstruction.展开更多
Anterior cruciate ligament(ACL)injury is one of the most common types of sports injuries.People’s need to participate in sports and desire for a high quality of life promotes the continuous development of ACL reconst...Anterior cruciate ligament(ACL)injury is one of the most common types of sports injuries.People’s need to participate in sports and desire for a high quality of life promotes the continuous development of ACL reconstruction technology.Arthroscopic ACL reconstruction has been recognized as an effective method for the treatment of ACL injuries.This review analyses and summarizes the advantages and limitations of each surgical procedure for arthroscopic ACL reconstruction reported in the relevant literature so as to promote the future development of more relevant techniques.展开更多
BACKGROUND The medial patellofemoral ligament(MPFL),along with the medial patellotibial ligament(MPTL)and medial patellomeniscal ligament,aid in the stabilization of the patellofemoral joint.Although the MPFL is the p...BACKGROUND The medial patellofemoral ligament(MPFL),along with the medial patellotibial ligament(MPTL)and medial patellomeniscal ligament,aid in the stabilization of the patellofemoral joint.Although the MPFL is the primary stabilizer and the MPTL is a secondary limiter,this ligament is critical in maintaining joint stability.There have been few studies on the combined MPFL and MPTL reconstruction and its benefits.AIM To look into the outcomes of combined MPFL and MPTL reconstruction in frequent patellar instability.METHODS By May 8,2022,four electronic databases were searched:Medline(PubMed),Scopus,Web of Science,and Google Scholar.General keywords such as"patellar instability,""patellar dislocation,""MPFL,""medial patellofemoral ligament,""MPTL,"and"medial patellotibial ligament"were co-searched to increase the sensitivity of the search.RESULTS The pooled effects of combined MPFL and MPTL reconstruction for Kujala score(12-mo followup)and Kujala score(24-mo follow-up)were positive and incremental,according to the findings of this meta-analysis.The mean difference between the Cincinnati scores was also positive,but not statistically significant.The combination of the two surgeries reduces pain.According to cumulative meta-analysis,the trend of pain reduction in various studies is declining over time.CONCLUSION The combined MPFL and MPTL reconstruction has good clinical results in knee function and,in addition to providing good control to maintain patellofemoral joint balance,the patient's pain level decreases over time,making it a valid surgical method for patella stabilization.展开更多
Injury to the anterior talofibular ligament(ATFL)is a common acute injury of the lateral foot ligament.Untimely and improper treatment significantly affects the quality of life and rehabilitation progress of patients....Injury to the anterior talofibular ligament(ATFL)is a common acute injury of the lateral foot ligament.Untimely and improper treatment significantly affects the quality of life and rehabilitation progress of patients.The purpose of this paper is to review the anatomy and the current methods of diagnosis and treatment of acute injury to the ATFL.The clinical manifestations of acute injury to the ATFL include pain,swelling,and dysfunction.At present,non-surgical treatment is the first choice for acute injury of the ATFL.The standard treatment strategy involves the“peace and love”principle.After initial treatment in the acute phase,personalized rehabilitation training programs can be followed.These may involve proprioception training,muscle training,and functional exercise to restore limb coordination and muscle strength.Static stretching and other techniques to loosen joints,acupuncture,moxibustion massage,and other traditional medical treatments can relieve pain,restore range of motion,and prevent joint stiffness.If the non-surgical treatment is not ideal or fails,surgical treatment is feasible.Currently,arthroscopic anatomical repair or anatomical reconstruction surgery is commonly used in clinical practice.Although open Broström surgery provides good results,the modified arthroscopic Broström surgery has many advantages,such as less trauma,rapid pain relief,rapid postoperative recovery,and fewer complications,and is more popular with patients.In general,when treating acute injury to the ATFL,treatment management and methods should be timely and reasonably arranged according to the specific injury scenario and attention should be paid to the timely combination of multiple therapies to achieve the best treatment results.展开更多
BACKGROUND Closed loop ileus caused by entrapment of bowel in a defect of the broad ligament is a rarity.Only a few cases have been reported in the literature.CASE SUMMARY We present the case of a 44-year-old,healthy ...BACKGROUND Closed loop ileus caused by entrapment of bowel in a defect of the broad ligament is a rarity.Only a few cases have been reported in the literature.CASE SUMMARY We present the case of a 44-year-old,healthy patient with no prior history of abdominal surgery who developed a closed loop ileus due to an internal hernia secondary to a defect in the right broad ligament.She first presented to the emergency department with diarrhea and vomiting.As she had had no previous abdominal surgery,she was diagnosed with probable gastroenteritis and discharged.The patient subsequently returned to the emergency department due to a lack of improvement in her symptoms.Blood tests showed an elevated white blood cell count and a closed loop ileus was diagnosed on an abdominal computer tomography scan.Diagnostic laparoscopy revealed an internal hernia entrapped in a 2 cm large defect in the right broad ligament.The hernia was reduced and the ligament defect was closed using a running,barbed suture.CONCLUSION Bowel incarceration through an internal hernia may present with misleading symptoms and laparoscopy may reveal unexpected findings.展开更多
BACKGROUND Anterior cruciate ligament(ACL)tears are common sports-related injuries.Their incidence is not the same either for all the sports or for the same sport across various nations.This information is maintained ...BACKGROUND Anterior cruciate ligament(ACL)tears are common sports-related injuries.Their incidence is not the same either for all the sports or for the same sport across various nations.This information is maintained by many sports leagues in their registries.However,very few nationwide registries exist for such injuries.This study is carried out to know the demographic characteristics of patients who underwent ACL reconstruction at our hospital in India.AIM To know the demographic characteristics of patients who underwent ACL reconstruction at a tertiary care hospital in India.METHODS All the patients who underwent ACL reconstruction from January 2020 to December 2021 were retrospectively studied.Patients with multi-ligament injuries or a history of previous knee surgery were excluded.The patients’history was obtained from the hospital records,they were interviewed telephonically,and online questionnaires were given.Their demographic data was analyzed and compared to the existing literature.RESULTS A total of 124 patients were operated on for ACL reconstruction during this period.The mean age of the patients was 27.97 years.One hundred and thirteen patients(91.1%)were male and 11(8.9%)were female.The majority of the patients(47.6%)sustained this injury by road traffic accidents(RTA)followed by sportsrelated injuries(39.5%).The commonest presenting complaint was giving way of the knee in 118 patients(95.2%).The mean duration from the injury to the first hospital visit among the patients was 290.1 d.The mean duration from the injury to surgery was 421.8 d.CONCLUSION ACL patients’demography is different in developing nations as compared to the developed world.RTA are the leading cause of ACL injuries and are followed by recreational sports as a cause.There is delayed access to healthcare leading to delayed diagnosis as well as even greater time to surgery.This,in turn,leads to poorer prognosis and longer rehabilitation.National registries for developing nations are the need of the hour due to the different demographics of ACL injuries in developing countries.展开更多
Pathological implications of the falciform ligament are rare and internal hernias are exceptional. The origin of the falciform ligament defect can be congenital or inflammatory (a satellite of acute cholecystitis) or ...Pathological implications of the falciform ligament are rare and internal hernias are exceptional. The origin of the falciform ligament defect can be congenital or inflammatory (a satellite of acute cholecystitis) or even post-surgical. The internal hernias of the falciform ligament are most often revealed by an acute intestinal obstruction syndrome with an ischemic component. The scanner provides the benchmarking examination allowing us to conduct a positive diagnosis and see also the inherent complications, which drives us to take the appropriate and fast surgical procedures. It is an entity that must be known.展开更多
Objective:Pelvic organ prolapse(POP)is a common gynecological disease in middle-aged and older women that seriously affects patients'physical health and quality of life,increases the financial burden for patients,...Objective:Pelvic organ prolapse(POP)is a common gynecological disease in middle-aged and older women that seriously affects patients'physical health and quality of life,increases the financial burden for patients,and becomes a major public health concern.The aim of this study was to investigate the medium-term outcomes of laparoscopic pubocervical fascia reconstruction and sacrospinous ligament fixation with a posterior approach for patients with severe POP.Methods:Patients with severe POP quantitation stage III-IV who underwent laparoscopic pubocervical fascia reconstruction and sacrospinous ligament fixation with a posterior approach at the Department of Obstetrics and Gynecology,Sir Run Run Shaw Hospital,Zhejiang University School of Medicine between September 2016 and December 2020 were enrolled in this study.The results and complications were recorded.Data were retrospectively reviewed.Results:In total,124 patients were analyzed.Patients were followed up for 32.2712.90 months.The objective cure rate for patients who underwent hysterectomy was 917%(100/109),with 7(6.4%)patients had anterior vaginal wall prolapse and 2(1.8%)patients had posterior vaginal wall prolapse.The objective cure rate for patients who retained uterus was 66.7%(10/15).All 5 patients with recurrence had uterine prolapse,and 3(20.0%)of them also had anterior vaginal wall prolapse.Conchusions:Laparoscopic pubocervical fascia reconstruction and sacrospinous ligament fixation with the posterior approach is a safe,minimally invasive,and effective method for patients with severe POP.Long-term follow-up is needed to confirm the clinical effects.展开更多
BACKGROUND Cyclops lesions are a known complication of anterior cruciate ligament(ACL)reconstruction,with symptomatic cyclops syndrome occurring in up to 11%of surgeries.Recurrent cyclops lesions have been rarely docu...BACKGROUND Cyclops lesions are a known complication of anterior cruciate ligament(ACL)reconstruction,with symptomatic cyclops syndrome occurring in up to 11%of surgeries.Recurrent cyclops lesions have been rarely documented;this case study documents the successful treatment of a recurrent cyclops lesion.CASE SUMMARY A 28-year-old female presented following a non-contact injury to the right knee.Workup and clinical exam revealed an ACL tear,and arthroscopic reconstruction was performed.Two years later a cyclops lesion was discovered and removed via arthroscopic synovectomy.Seven months postoperatively,the patient presented with pain,stiffness,and difficulty achieving terminal extension.A smaller recurrent cyclops lesion was diagnosed,and a repeat synovectomy was performed.The patient recovered fully.CONCLUSION To the best of our knowledge,this is the first documented case of recurrent cyclops lesion after bone-patellar tendon-bone allograft ACL reconstruction presenting as cyclops syndrome.展开更多
BACKGROUND Laparoscopic sacrocolpopexy for pelvic organ prolapse(POP)is a new and widely used approach;however,ever since the United States Food and Drug Administration warned against the use of surgical mesh,repairs ...BACKGROUND Laparoscopic sacrocolpopexy for pelvic organ prolapse(POP)is a new and widely used approach;however,ever since the United States Food and Drug Administration warned against the use of surgical mesh,repairs performed using patients’tissues[i.e.native tissue repair(NTR)]instead of mesh have attracted much attention.At our hospital,laparoscopic sacrocolpopexy(the Shull method)was introduced in 2017.However,patients with more severe POP who have a long vaginal canal and overextended uterosacral ligaments may not be candidates for this procedure.AIM To validate a new NTR treatment for POP,we examined patients undergoing laparoscopic vaginal stump–round ligament fixation(the Kakinuma method).METHODS The study patients were 30 individuals with POP who underwent surgery using the Kakinuma method between January 2020 and December 2021 and who were followed up for>12 mo after surgery.We retrospectively examined surgical outcomes for surgery duration,blood loss,intraoperative complications,and incidence of recurrence.The Kakinuma method involves round ligament suturing and fixation on both sides,effectively lifting the vaginal stump after laparoscopic hysterectomy.RESULTS The patients’mean age was 66.5±9.1(45-82)years,gravidity was 3.1±1.4(2-7),parity was 2.5±0.6(2-4)times,and body mass index was 24.5±3.3(20.9-32.8)kg/m2.According to the POP quantification stage classification,there were 8 patients with stage Ⅱ,11 with stage Ⅲ,and 11 with stage Ⅳ.The mean surgery duration was 113.4±22.6(88-148)min,and the mean blood loss was 26.5±39.7(10-150)mL.There were no perioperative complications.None of the patients exhibited reduced activities of daily living or cognitive impairment after hospital discharge.No cases of POP recurrence were observed 12 mo after the operation.CONCLUSION The Kakinuma method,similar to conventional NTR,may be an effective treatment for POP.展开更多
BACKGROUND Median arcuate ligament syndrome(MALS)is a rare disease caused by compression of the celiac trunk artery by the median arcuate ligament(MAL).It can cause symptoms of postprandial abdominal pain,weight loss,...BACKGROUND Median arcuate ligament syndrome(MALS)is a rare disease caused by compression of the celiac trunk artery by the median arcuate ligament(MAL).It can cause symptoms of postprandial abdominal pain,weight loss,and nausea and vomiting.CASE SUMMARY A 55-year-old woman was admitted due to abdominal pain,nausea and vomiting.On admission,the patient presented with epigastric pain that worsened after eating,without signs of peritoneal irritation.Computed tomography angiography of the upper abdomen showed compression of the proximal segment of the abdominal trunk,local luminal stenosis with angular“fishhook”changes,which changed significantly during forceful inspiration and expiration;gallbladder stones;and multiple cysts in the liver.Abdominal duplex ultrasonography showed that peak systolic velocity was 352 cm/s.After diagnosis of MALS was confirmed,an arch ligament release procedure was performed.MALS has no specific symptoms and can be misdiagnosed as other abdominal diseases.Awareness of MALS should be improved to avoid misdiagnosis.The commonly used treatment option is MAL release and resection of the peripheral ganglion of the celiac trunk artery.CONCLUSION The diagnosis and treatment of MALS must be individualized,and MAL release is effective and provides immediate symptomatic relief.展开更多
BACKGROUND A healthy body shape is essential to maintain athletes’sports level.At present,little is known about the effect of athletes’body shape on anterior cruciate ligament reconstruction(ACLR).Moreover,the relat...BACKGROUND A healthy body shape is essential to maintain athletes’sports level.At present,little is known about the effect of athletes’body shape on anterior cruciate ligament reconstruction(ACLR).Moreover,the relationship between body shape and variables such as knee joint function after operation and return to the field has not been well studied.AIM To verify the relationship between a body shape index(ABSI)and the functional prognosis of the knee after ACLR in athletes with ACL injuries.METHODS We reviewed 76 athletes with unilateral ACL ruptures who underwent ACLR surgery in the First Hospital of Shanxi Medical University between 2017 and 2020,with a follow-up period of more than 24 mo.First,all populations were divided into a High-ABSI group(ABSI>0.835,n=38)and a Low-ABSI group(ABSI<0.835,n=38)based on the arithmetic median(0.835)of ABSI values.The primary exposure factor was ABSI,and the outcome indicators were knee function scores as well as postoperative complications.The correlation between ABSI and postoperative knee function scores and postoperative complications after ACLR were analyzed using multifactorial logistic regression.RESULTS The preoperative knee function scores of the two groups were similar.The surgery and postoperative rehabilitation exercises,range of motion(ROM)compliance rate,Lysholm score,and Knee Injury and Osteoarthritis Outcome Score of the two groups gradually increased,whereas the quadriceps atrophy index gradually decreased.The knee function scores were higher in the Low-ABSI group than in the High-ABSI group at the 24-mo postoperative follow-up(P<0.05).In multifactorial logistic regression,ABSI was a risk factor of low knee joint function score after surgery,specifically low ROM scores(odds ratio[OR]=1.31,95%confidence interval[CI][1.10-1.44];P<0.001),low quadriceps atrophy index(OR=1.11,95%CI[0.97-1.29];P<0.05),low Lysholm scores(OR=2.34,95%CI[1.78-2.94];P<0.001),low symptoms(OR=1.14,95%CI[1.02-1.34];P<0.05),low activity of daily living(OR=1.34,95%CI[1.18-1.65];P<0.05),low sports(OR=2.47,95%CI[1.78-2.84];P<0.001),and low quality of life(OR=3.34,95%CI[2.88-3.94];P<0.001).ABSI was also a risk factor for deep vein thrombosis of the lower limb(OR=2.14,95%CI[1.88-2.36],P<0.05]and ACL recurrent rupture(OR=1.24,95%CI[0.98-1.44],P<0.05)after ACLR.CONCLUSION ABSI is a risk factor for the poor prognosis of knee function in ACL athletes after ACLR,and the risk of poor knee function after ACLR,deep vein thrombosis of lower limb,and ACL recurrent rupture gradually increases with the rise of ABSI.展开更多
BACKGROUND The anteromedial meniscofemoral ligament(AMMFL)is a very rare entity,commonly unrecognized and underreported.Although it was not proved to be a cause of anterior knee pain,concerns have been raised on the r...BACKGROUND The anteromedial meniscofemoral ligament(AMMFL)is a very rare entity,commonly unrecognized and underreported.Although it was not proved to be a cause of anterior knee pain,concerns have been raised on the relationship between the presence of this structure and medial meniscus injury secondary to its abnormal motion.Regarding histologic examination,some studies have shown meniscus-like fibrocartilage,while others have identified it as ligament-like collagenous fibrous connective tissue.CASE SUMMARY We report the case of a 34-year-old ballerina with an AMMFL associated with a torn medial meniscus of both knees.Surgery was performed to treat the meniscal injury and two biopsies of each AMMFL were taken in different locations to define the histopathological composition.Histologic examination revealed fibrocartilaginous tissue compatible with meniscus.Follow-up evaluation one year after surgery evidenced full remission of symptoms and the patient had resumed her athletic activities.CONCLUSION Clinical,magnetic resonance imaging,arthroscopic,and histological features have been carefully described to better characterize the AMMFL.展开更多
BACKGROUND Dedifferentiated liposarcoma(DDLS)has a worse prognosis and occurs most commonly in the retroperitoneal region and rarely in the intraperitoneal region.Histological diagnosis was revolutionized by the combi...BACKGROUND Dedifferentiated liposarcoma(DDLS)has a worse prognosis and occurs most commonly in the retroperitoneal region and rarely in the intraperitoneal region.Histological diagnosis was revolutionized by the combined contributions of histoimmuno-chemistry and molecular biology.Aside from surgery,there is no consensus on the optimal treatment for this chemoresistant cancer.CASE SUMMARY A thirty-year-old black female presented with a large painful abdominal mass occupying nearly the entire abdomen and progressive weight loss was admitted for surgery.Abdominal computed tomography showed a large heterogeneous mass of the mesentery that was sized 18 cm×16 cm in size and had heterogeneous contrast enhancement.During laparotomy,en bloc excision of the large and multilobulated gastrocolic ligament mass was performed.The initial postoperative histopathological diagnosis was undifferentiated sarcoma.Finally,the results of immunohistochemistry and molecular biology allowed us to confirm the diagnosis of DDLS.The tumour followed an aggressive evolution with diffuse metastasis,causing the death of the patient less than 5 mo after the operation.CONCLUSION Dedifferentiated liposarcomas are rare tumours that typically originate in the retroperitoneum but may arise in unexpected locations.展开更多
The median arcuate ligament syndrome(MALS)is recognized as a rare clinical entity,characterized by chronic post-prandial abdominal pain,nausea,vomiting,and unintentional weight loss.Due to its vague symptomatology,it ...The median arcuate ligament syndrome(MALS)is recognized as a rare clinical entity,characterized by chronic post-prandial abdominal pain,nausea,vomiting,and unintentional weight loss.Due to its vague symptomatology,it is mainly regarded as a diagnosis of exclusion.Patients can often be misdiagnosed for several years before a correct diagnosis is established,also due to a medical team’s clinical suspicion.We present a case series of two patients who suffered from MALS and were treated successfully.The first patient is a 32-year-old woman,presenting with post-prandial abdominal pain and weight loss that have lasted for the past ten years.The second patient,a 50-year-old woman,presented with similar symptomatology,with the symptoms lasting for the last five years.Both cases were treated by laparoscopic division of the median arcuate ligament fibers,which alleviated extrinsic pressure from the celiac artery.Previous cases of MALS were retrieved from PubMed,to assemble a better diagnostic algorithm and propose a treatment method of choice.The literature review suggests an angiography with a respiratory variation protocol as the diagnostic modality of choice,along with the laparoscopic division of the median arcuate ligament fibers as the proposed treatment of choice.展开更多
文摘Broad ligament hematoma is typically seen during cesarean section due to rupture of branches of uterine and vaginal vessels and it’s rare to be seen post-normal vaginal delivery. Addressing puerperal hematomas postpartum presents considerable challenges for obstetric care providers. While hematomas such as those affecting the vulva, vulvovaginal region, or paravaginal area are frequently encountered, retroperitoneal hematomas are rare and notably pose a greater risk to the life of the patient. The medical literature contains scant case reports on retroperitoneal hematomas, with no consensus on a definitive treatment approach. Pelvic arterial embolization has emerged as both a sensible and increasingly preferred method for treating these hematomas recently, but its application is contingent upon the patient maintaining hemodynamic stability and the availability of a specialized interventional embolization unit. In our case, we are presenting a very rare case of a 31-year-old primigravida female with a history of in vitro fertilization pregnancy. She delivered a normal vaginal delivery at 31 weeks gestation. Unfortunately, she experienced multiple complications intrapartum, including preeclampsia and placental abruption. These complications increased her risk of developing a broad ligament hematoma.
文摘Symptomatic cyclops lesions are complications that can be seen at rates of up to approximately 10%after anterior cruciate ligament reconstruction.However,recurrent cyclops lesions have rarely been documented.There are case rare series in the literature regarding the treatment of recurrent cyclops lesion.Future large studies are needed to investigate factors contributing to the development of cyclops lesions and syndrome and treatment options.
文摘Introduction: Acromioclavicular (AC) joint dislocation is a common shoulder injury, comprising 9% - 12% of shoulder girdle injuries. Optimal management remains challenging, with treatment decisions guided by the Rockwood classification system. Controversies surround grade III injuries, necessitating further classification. Non-operative treatment has shown favorable outcomes, while surgical interventions vary. Anatomical coracoclavicular reconstruction (ACCR) has demonstrated biomechanical advantages over traditional methods. Arthroscopic techniques offer advantages, minimizing deltoid detachment and allowing concurrent pathology identification. This study evaluates the outcomes of arthroscopic-assisted ACCR in chronic AC joint dislocation. Surgical Technique: Arthroscopic-assisted ACCR involves meticulous portal placement, tendon graft harvesting, diagnostic arthroscopy, and coracoid exposure. The clavicle tunnels were made to mimic the conoid and trapezoid ligament positions, using FibreTape#2 loop and Dog Bone Button for correct placement against the coracoid base, and passing the semitendinosus graft through to reconstruct the conoid ligament, reduction done and graft follow through for anatomical reconstruction. Methods: A retrospective cohort study at Hospital Kuala Lumpur analyzed 35 patients undergoing arthroscopic-assisted ACCR for Rockwood grade III - V AC joint dislocations. Inclusion criteria encompassed trauma ≥ 3 weeks prior, no prior shoulder injuries, and ≥12-month follow-up. Functional and radiological assessments utilized ASES scores and coracoclavicular distances, respectively. Statistical analysis employed descriptive statistics and logistic regression. Results: The mean age was 38.9 years (SD 11.26), and 34 of 35 patients were male. Grade IV injuries were predominant (37.1%). Waiting time for surgery averaged 234.9 days. Functional improvement was substantial postoperatively (ASES: 55.5 to 88.9). Radiological outcomes demonstrated reduced coracoclavicular distances and maintained reduction. No significant correlation was observed between injury grade and outcomes. Conclusion: Arthroscopic-assisted ACCR for chronic AC joint dislocation yields significant functional and radiological improvement, irrespective of injury grade. Waiting time for surgery exhibits minor impact on outcomes, emphasizing the procedure’s efficacy. Concomitant injuries do not impede success, highlighting the versatility of this approach in managing shoulder instability. The study contributes valuable insights into the nuanced management of chronic AC joint dislocations and supports the adoption of arthroscopic-assisted ACCR as a viable treatment option.
文摘BACKGROUND Many studies have focused on the femoral tunnel technique and fixation method,but few studies have involved the tibial tunnel technique and fixation method.The all-inside technique is one of the new techniques that has been described in recent years.All-inside anterior cruciate ligament(ACL)reconstruction is based on a tibial socket instead of a full tunnel.This method has many potential advantages.AIM To compare clinical outcomes of knee ACL autograft reconstruction using allinside quadrupled semitendinosus(AIST)and traditional hamstring tendon(TBT)techniques.METHODS From January 2017 to October 2019,the clinical data of 80 patients with ACL reconstruction were retrospectively analyzed,including 67 males and 13 females.The patients had an average age of 24.3±3.1 years(age range:18-33 years).The AIST technique was used in 42 patients and the TBT technique was used in 38 patients.The time between operation and injury,operative duration,postoperative visual analogue scale(VAS)score and knee functional recovery were recorded and compared between the two groups.The International Knee Documentation Committee(IKDC)and Lysholm scoring system were used to comprehensively evaluate clinical efficacy.RESULTS Eighty patients were followed for 24-36 mo,with an average follow-up duration of 27.5±1.8 mo.There were no significant differences in the time between surgery and injury,operative duration,IKDC and Lysholm scores of the affected knee at the last follow-up evaluation between the two groups.There were significant differences in VAS scores 1 d,3 d,7 d,2 wk and 1 mo after surgery(P<0.05).There was no significant difference in VAS score at 3 mo,6 mo and 1 year after operation.CONCLUSION The efficacy of the AIST ACL reconstruction technique was comparable to the TBT technique,but the postoperative pain was less with the AIST technique.Thus,the AIST technique is an ideal treatment choice for ACL reconstruction.
文摘Anterior cruciate ligament(ACL)injury is one of the most common types of sports injuries.People’s need to participate in sports and desire for a high quality of life promotes the continuous development of ACL reconstruction technology.Arthroscopic ACL reconstruction has been recognized as an effective method for the treatment of ACL injuries.This review analyses and summarizes the advantages and limitations of each surgical procedure for arthroscopic ACL reconstruction reported in the relevant literature so as to promote the future development of more relevant techniques.
文摘BACKGROUND The medial patellofemoral ligament(MPFL),along with the medial patellotibial ligament(MPTL)and medial patellomeniscal ligament,aid in the stabilization of the patellofemoral joint.Although the MPFL is the primary stabilizer and the MPTL is a secondary limiter,this ligament is critical in maintaining joint stability.There have been few studies on the combined MPFL and MPTL reconstruction and its benefits.AIM To look into the outcomes of combined MPFL and MPTL reconstruction in frequent patellar instability.METHODS By May 8,2022,four electronic databases were searched:Medline(PubMed),Scopus,Web of Science,and Google Scholar.General keywords such as"patellar instability,""patellar dislocation,""MPFL,""medial patellofemoral ligament,""MPTL,"and"medial patellotibial ligament"were co-searched to increase the sensitivity of the search.RESULTS The pooled effects of combined MPFL and MPTL reconstruction for Kujala score(12-mo followup)and Kujala score(24-mo follow-up)were positive and incremental,according to the findings of this meta-analysis.The mean difference between the Cincinnati scores was also positive,but not statistically significant.The combination of the two surgeries reduces pain.According to cumulative meta-analysis,the trend of pain reduction in various studies is declining over time.CONCLUSION The combined MPFL and MPTL reconstruction has good clinical results in knee function and,in addition to providing good control to maintain patellofemoral joint balance,the patient's pain level decreases over time,making it a valid surgical method for patella stabilization.
文摘Injury to the anterior talofibular ligament(ATFL)is a common acute injury of the lateral foot ligament.Untimely and improper treatment significantly affects the quality of life and rehabilitation progress of patients.The purpose of this paper is to review the anatomy and the current methods of diagnosis and treatment of acute injury to the ATFL.The clinical manifestations of acute injury to the ATFL include pain,swelling,and dysfunction.At present,non-surgical treatment is the first choice for acute injury of the ATFL.The standard treatment strategy involves the“peace and love”principle.After initial treatment in the acute phase,personalized rehabilitation training programs can be followed.These may involve proprioception training,muscle training,and functional exercise to restore limb coordination and muscle strength.Static stretching and other techniques to loosen joints,acupuncture,moxibustion massage,and other traditional medical treatments can relieve pain,restore range of motion,and prevent joint stiffness.If the non-surgical treatment is not ideal or fails,surgical treatment is feasible.Currently,arthroscopic anatomical repair or anatomical reconstruction surgery is commonly used in clinical practice.Although open Broström surgery provides good results,the modified arthroscopic Broström surgery has many advantages,such as less trauma,rapid pain relief,rapid postoperative recovery,and fewer complications,and is more popular with patients.In general,when treating acute injury to the ATFL,treatment management and methods should be timely and reasonably arranged according to the specific injury scenario and attention should be paid to the timely combination of multiple therapies to achieve the best treatment results.
文摘BACKGROUND Closed loop ileus caused by entrapment of bowel in a defect of the broad ligament is a rarity.Only a few cases have been reported in the literature.CASE SUMMARY We present the case of a 44-year-old,healthy patient with no prior history of abdominal surgery who developed a closed loop ileus due to an internal hernia secondary to a defect in the right broad ligament.She first presented to the emergency department with diarrhea and vomiting.As she had had no previous abdominal surgery,she was diagnosed with probable gastroenteritis and discharged.The patient subsequently returned to the emergency department due to a lack of improvement in her symptoms.Blood tests showed an elevated white blood cell count and a closed loop ileus was diagnosed on an abdominal computer tomography scan.Diagnostic laparoscopy revealed an internal hernia entrapped in a 2 cm large defect in the right broad ligament.The hernia was reduced and the ligament defect was closed using a running,barbed suture.CONCLUSION Bowel incarceration through an internal hernia may present with misleading symptoms and laparoscopy may reveal unexpected findings.
文摘BACKGROUND Anterior cruciate ligament(ACL)tears are common sports-related injuries.Their incidence is not the same either for all the sports or for the same sport across various nations.This information is maintained by many sports leagues in their registries.However,very few nationwide registries exist for such injuries.This study is carried out to know the demographic characteristics of patients who underwent ACL reconstruction at our hospital in India.AIM To know the demographic characteristics of patients who underwent ACL reconstruction at a tertiary care hospital in India.METHODS All the patients who underwent ACL reconstruction from January 2020 to December 2021 were retrospectively studied.Patients with multi-ligament injuries or a history of previous knee surgery were excluded.The patients’history was obtained from the hospital records,they were interviewed telephonically,and online questionnaires were given.Their demographic data was analyzed and compared to the existing literature.RESULTS A total of 124 patients were operated on for ACL reconstruction during this period.The mean age of the patients was 27.97 years.One hundred and thirteen patients(91.1%)were male and 11(8.9%)were female.The majority of the patients(47.6%)sustained this injury by road traffic accidents(RTA)followed by sportsrelated injuries(39.5%).The commonest presenting complaint was giving way of the knee in 118 patients(95.2%).The mean duration from the injury to the first hospital visit among the patients was 290.1 d.The mean duration from the injury to surgery was 421.8 d.CONCLUSION ACL patients’demography is different in developing nations as compared to the developed world.RTA are the leading cause of ACL injuries and are followed by recreational sports as a cause.There is delayed access to healthcare leading to delayed diagnosis as well as even greater time to surgery.This,in turn,leads to poorer prognosis and longer rehabilitation.National registries for developing nations are the need of the hour due to the different demographics of ACL injuries in developing countries.
文摘Pathological implications of the falciform ligament are rare and internal hernias are exceptional. The origin of the falciform ligament defect can be congenital or inflammatory (a satellite of acute cholecystitis) or even post-surgical. The internal hernias of the falciform ligament are most often revealed by an acute intestinal obstruction syndrome with an ischemic component. The scanner provides the benchmarking examination allowing us to conduct a positive diagnosis and see also the inherent complications, which drives us to take the appropriate and fast surgical procedures. It is an entity that must be known.
基金supported by the National Key Research and Development Program of China(2018YFC1004800)the Scien-tific Research Fund of Zhejiang Provincial Education Department(Y2020433-40)。
文摘Objective:Pelvic organ prolapse(POP)is a common gynecological disease in middle-aged and older women that seriously affects patients'physical health and quality of life,increases the financial burden for patients,and becomes a major public health concern.The aim of this study was to investigate the medium-term outcomes of laparoscopic pubocervical fascia reconstruction and sacrospinous ligament fixation with a posterior approach for patients with severe POP.Methods:Patients with severe POP quantitation stage III-IV who underwent laparoscopic pubocervical fascia reconstruction and sacrospinous ligament fixation with a posterior approach at the Department of Obstetrics and Gynecology,Sir Run Run Shaw Hospital,Zhejiang University School of Medicine between September 2016 and December 2020 were enrolled in this study.The results and complications were recorded.Data were retrospectively reviewed.Results:In total,124 patients were analyzed.Patients were followed up for 32.2712.90 months.The objective cure rate for patients who underwent hysterectomy was 917%(100/109),with 7(6.4%)patients had anterior vaginal wall prolapse and 2(1.8%)patients had posterior vaginal wall prolapse.The objective cure rate for patients who retained uterus was 66.7%(10/15).All 5 patients with recurrence had uterine prolapse,and 3(20.0%)of them also had anterior vaginal wall prolapse.Conchusions:Laparoscopic pubocervical fascia reconstruction and sacrospinous ligament fixation with the posterior approach is a safe,minimally invasive,and effective method for patients with severe POP.Long-term follow-up is needed to confirm the clinical effects.
文摘BACKGROUND Cyclops lesions are a known complication of anterior cruciate ligament(ACL)reconstruction,with symptomatic cyclops syndrome occurring in up to 11%of surgeries.Recurrent cyclops lesions have been rarely documented;this case study documents the successful treatment of a recurrent cyclops lesion.CASE SUMMARY A 28-year-old female presented following a non-contact injury to the right knee.Workup and clinical exam revealed an ACL tear,and arthroscopic reconstruction was performed.Two years later a cyclops lesion was discovered and removed via arthroscopic synovectomy.Seven months postoperatively,the patient presented with pain,stiffness,and difficulty achieving terminal extension.A smaller recurrent cyclops lesion was diagnosed,and a repeat synovectomy was performed.The patient recovered fully.CONCLUSION To the best of our knowledge,this is the first documented case of recurrent cyclops lesion after bone-patellar tendon-bone allograft ACL reconstruction presenting as cyclops syndrome.
文摘BACKGROUND Laparoscopic sacrocolpopexy for pelvic organ prolapse(POP)is a new and widely used approach;however,ever since the United States Food and Drug Administration warned against the use of surgical mesh,repairs performed using patients’tissues[i.e.native tissue repair(NTR)]instead of mesh have attracted much attention.At our hospital,laparoscopic sacrocolpopexy(the Shull method)was introduced in 2017.However,patients with more severe POP who have a long vaginal canal and overextended uterosacral ligaments may not be candidates for this procedure.AIM To validate a new NTR treatment for POP,we examined patients undergoing laparoscopic vaginal stump–round ligament fixation(the Kakinuma method).METHODS The study patients were 30 individuals with POP who underwent surgery using the Kakinuma method between January 2020 and December 2021 and who were followed up for>12 mo after surgery.We retrospectively examined surgical outcomes for surgery duration,blood loss,intraoperative complications,and incidence of recurrence.The Kakinuma method involves round ligament suturing and fixation on both sides,effectively lifting the vaginal stump after laparoscopic hysterectomy.RESULTS The patients’mean age was 66.5±9.1(45-82)years,gravidity was 3.1±1.4(2-7),parity was 2.5±0.6(2-4)times,and body mass index was 24.5±3.3(20.9-32.8)kg/m2.According to the POP quantification stage classification,there were 8 patients with stage Ⅱ,11 with stage Ⅲ,and 11 with stage Ⅳ.The mean surgery duration was 113.4±22.6(88-148)min,and the mean blood loss was 26.5±39.7(10-150)mL.There were no perioperative complications.None of the patients exhibited reduced activities of daily living or cognitive impairment after hospital discharge.No cases of POP recurrence were observed 12 mo after the operation.CONCLUSION The Kakinuma method,similar to conventional NTR,may be an effective treatment for POP.
文摘BACKGROUND Median arcuate ligament syndrome(MALS)is a rare disease caused by compression of the celiac trunk artery by the median arcuate ligament(MAL).It can cause symptoms of postprandial abdominal pain,weight loss,and nausea and vomiting.CASE SUMMARY A 55-year-old woman was admitted due to abdominal pain,nausea and vomiting.On admission,the patient presented with epigastric pain that worsened after eating,without signs of peritoneal irritation.Computed tomography angiography of the upper abdomen showed compression of the proximal segment of the abdominal trunk,local luminal stenosis with angular“fishhook”changes,which changed significantly during forceful inspiration and expiration;gallbladder stones;and multiple cysts in the liver.Abdominal duplex ultrasonography showed that peak systolic velocity was 352 cm/s.After diagnosis of MALS was confirmed,an arch ligament release procedure was performed.MALS has no specific symptoms and can be misdiagnosed as other abdominal diseases.Awareness of MALS should be improved to avoid misdiagnosis.The commonly used treatment option is MAL release and resection of the peripheral ganglion of the celiac trunk artery.CONCLUSION The diagnosis and treatment of MALS must be individualized,and MAL release is effective and provides immediate symptomatic relief.
文摘BACKGROUND A healthy body shape is essential to maintain athletes’sports level.At present,little is known about the effect of athletes’body shape on anterior cruciate ligament reconstruction(ACLR).Moreover,the relationship between body shape and variables such as knee joint function after operation and return to the field has not been well studied.AIM To verify the relationship between a body shape index(ABSI)and the functional prognosis of the knee after ACLR in athletes with ACL injuries.METHODS We reviewed 76 athletes with unilateral ACL ruptures who underwent ACLR surgery in the First Hospital of Shanxi Medical University between 2017 and 2020,with a follow-up period of more than 24 mo.First,all populations were divided into a High-ABSI group(ABSI>0.835,n=38)and a Low-ABSI group(ABSI<0.835,n=38)based on the arithmetic median(0.835)of ABSI values.The primary exposure factor was ABSI,and the outcome indicators were knee function scores as well as postoperative complications.The correlation between ABSI and postoperative knee function scores and postoperative complications after ACLR were analyzed using multifactorial logistic regression.RESULTS The preoperative knee function scores of the two groups were similar.The surgery and postoperative rehabilitation exercises,range of motion(ROM)compliance rate,Lysholm score,and Knee Injury and Osteoarthritis Outcome Score of the two groups gradually increased,whereas the quadriceps atrophy index gradually decreased.The knee function scores were higher in the Low-ABSI group than in the High-ABSI group at the 24-mo postoperative follow-up(P<0.05).In multifactorial logistic regression,ABSI was a risk factor of low knee joint function score after surgery,specifically low ROM scores(odds ratio[OR]=1.31,95%confidence interval[CI][1.10-1.44];P<0.001),low quadriceps atrophy index(OR=1.11,95%CI[0.97-1.29];P<0.05),low Lysholm scores(OR=2.34,95%CI[1.78-2.94];P<0.001),low symptoms(OR=1.14,95%CI[1.02-1.34];P<0.05),low activity of daily living(OR=1.34,95%CI[1.18-1.65];P<0.05),low sports(OR=2.47,95%CI[1.78-2.84];P<0.001),and low quality of life(OR=3.34,95%CI[2.88-3.94];P<0.001).ABSI was also a risk factor for deep vein thrombosis of the lower limb(OR=2.14,95%CI[1.88-2.36],P<0.05]and ACL recurrent rupture(OR=1.24,95%CI[0.98-1.44],P<0.05)after ACLR.CONCLUSION ABSI is a risk factor for the poor prognosis of knee function in ACL athletes after ACLR,and the risk of poor knee function after ACLR,deep vein thrombosis of lower limb,and ACL recurrent rupture gradually increases with the rise of ABSI.
文摘BACKGROUND The anteromedial meniscofemoral ligament(AMMFL)is a very rare entity,commonly unrecognized and underreported.Although it was not proved to be a cause of anterior knee pain,concerns have been raised on the relationship between the presence of this structure and medial meniscus injury secondary to its abnormal motion.Regarding histologic examination,some studies have shown meniscus-like fibrocartilage,while others have identified it as ligament-like collagenous fibrous connective tissue.CASE SUMMARY We report the case of a 34-year-old ballerina with an AMMFL associated with a torn medial meniscus of both knees.Surgery was performed to treat the meniscal injury and two biopsies of each AMMFL were taken in different locations to define the histopathological composition.Histologic examination revealed fibrocartilaginous tissue compatible with meniscus.Follow-up evaluation one year after surgery evidenced full remission of symptoms and the patient had resumed her athletic activities.CONCLUSION Clinical,magnetic resonance imaging,arthroscopic,and histological features have been carefully described to better characterize the AMMFL.
文摘BACKGROUND Dedifferentiated liposarcoma(DDLS)has a worse prognosis and occurs most commonly in the retroperitoneal region and rarely in the intraperitoneal region.Histological diagnosis was revolutionized by the combined contributions of histoimmuno-chemistry and molecular biology.Aside from surgery,there is no consensus on the optimal treatment for this chemoresistant cancer.CASE SUMMARY A thirty-year-old black female presented with a large painful abdominal mass occupying nearly the entire abdomen and progressive weight loss was admitted for surgery.Abdominal computed tomography showed a large heterogeneous mass of the mesentery that was sized 18 cm×16 cm in size and had heterogeneous contrast enhancement.During laparotomy,en bloc excision of the large and multilobulated gastrocolic ligament mass was performed.The initial postoperative histopathological diagnosis was undifferentiated sarcoma.Finally,the results of immunohistochemistry and molecular biology allowed us to confirm the diagnosis of DDLS.The tumour followed an aggressive evolution with diffuse metastasis,causing the death of the patient less than 5 mo after the operation.CONCLUSION Dedifferentiated liposarcomas are rare tumours that typically originate in the retroperitoneum but may arise in unexpected locations.
文摘The median arcuate ligament syndrome(MALS)is recognized as a rare clinical entity,characterized by chronic post-prandial abdominal pain,nausea,vomiting,and unintentional weight loss.Due to its vague symptomatology,it is mainly regarded as a diagnosis of exclusion.Patients can often be misdiagnosed for several years before a correct diagnosis is established,also due to a medical team’s clinical suspicion.We present a case series of two patients who suffered from MALS and were treated successfully.The first patient is a 32-year-old woman,presenting with post-prandial abdominal pain and weight loss that have lasted for the past ten years.The second patient,a 50-year-old woman,presented with similar symptomatology,with the symptoms lasting for the last five years.Both cases were treated by laparoscopic division of the median arcuate ligament fibers,which alleviated extrinsic pressure from the celiac artery.Previous cases of MALS were retrieved from PubMed,to assemble a better diagnostic algorithm and propose a treatment method of choice.The literature review suggests an angiography with a respiratory variation protocol as the diagnostic modality of choice,along with the laparoscopic division of the median arcuate ligament fibers as the proposed treatment of choice.
