Arthroscopic M-shaped suture fixation for tibia avulsion fracture of posterior cruciate ligament:A modified technique and case series

BACKGROUND Tibial avulsion fractures of the posterior cruciate ligament(PCL)are challenging to treat and compromise knee stability and function.Traditional open surgery often requires extensive soft tissue dissection,which may increase the risk of morbidity.In response to these concerns,arthroscopic techniques have been evolving.The aim of this study was to introduce a modified arthroscopic tech-nique utilizing an M-shaped suture fixation method for the treatment of tibial avulsion fractures of the PCL and to evaluate its outcomes through a case series.AIM To evaluate the effects of arthroscopic M-shaped suture fixation on treating tibia avulsion fractures of the PCL.METHODS We developed a modified arthroscopic M-shaped suture fixation technique for tibia avulsion fractures of the PCL.This case series included 18 patients who underwent the procedure between January 2021 and December 2022.The patients were assessed for range of motion(ROM),Lysholm score and International knee documentation committee(IKDC)score.Postoperative complications were also recorded.RESULTS The patients were followed for a mean of 13.83±2.33 months.All patients showed radiographic union.At the final follow-up,all patients had full ROM and a negative posterior drawer test.The mean Lysholm score significantly improved from 45.28±8.92 preoperatively to 91.83±4.18 at the final follow-up(P<0.001),and the mean IKDC score improved from 41.98±6.06 preoperatively to 90.89±5.32 at the final follow-up(P<0.001).CONCLUSION The modified arthroscopic M-shaped suture fixation technique is a reliable and effective treatment for tibia avulsion fractures of the PCL,with excellent fracture healing and functional recovery.

Clinical study of polydloxanone suture tension band fixation for treatment of patellar fractures

To explore biomechanic characteristics and clinical outcome of absorbable polydloxanone (PDS) treating patellar fractures.Methods The tensile strength test of PDS 0-0 or PDS 1-0 sutures were made in WDW305 electro-universal tester.A total of 60 cases were classified randomly and equally into two groups:treatment group (treated with the absorbable PDS tension hand) and Kirschner wire metals tension band control group (control group).Anatomy reduction was performed with towel clip fixation during operation.Treatment group was managed with diameter 1.5 mm Kirschner wires drilling two pores on the near or distal segment of patellar fracture end are penetrating through two strands of absorbable PDS 0-0 or PDS 1-0 sutures for a satisfactory fracture fixation.Control group was treated with Kirschner wires (2.0 mm in diameter) and steel wire (1.0 mm in diameter) of type “8” tension band fixation.Results Tensile strength testing showed that the biggest tensile of a strand PDS 0-0 sutures was 71.50 N and that of PDS 1-0 97.48 N,when the length was three times more than the initial.Two groups were followed up and the mean fracture healing time was two months,without broken wire or dislocation.Treatment group showed excellent clinical results in 21 cases,good in six and fair in three;while control group showed excellent clinical results in 19 cases,good in seven and fair in four,with no statistical difference compared with treatment group (χ2=0.32,P>0.05).Conclusion Absorbable PDS tension band has better characteristics of mechanics and creepage in treating patellar fractures.It can avoid defects of secondary operation and complications like needle-tail pain and sharped skin resulted from metal tension band fixation.Meanwhile,it is economic and worthy of further clinical application.16 refs,4 figs.

Corneal astigmatism correction with scleral flaps in trans-scleral suture-fixed posterior chamber lens implantation:a preliminary clinical observation

AIM: To study the impact of scleral flap position, under which the posterior chamber intraocular lenses (PC-IOL) were sulcus-fixed by trans-scleral suture, on cornea astigmatism. METHODS: Twenty-six aphakic or cataract eyes were comprised in this prospective noncomparative case series study. Eleven eyes had traumatic cataract removed without sufficient capsular support, 3 had blunt trauma with subluxated traumatic cataract, 8 had undergone vitreoretinal surgery and 4 had congenital cataract removed. The average age was 54 years (range 21-74 years), with 17 men and 7 women. The foldable PC-IOL was fixed in sulcus by trans-scleral suture. The incision for IOL implantation was made 1mm posterior to limbus along the steepest meridian of cornea, while scleral flaps to bury the knots of trans-scleral suture were made along the flattest meridian. All the surgeries were performed by a single doctor (Ma L), and the follow up was at least 13 months (range 13-28 months). The preoperative, 3 months and 1 year postoperative corneal curvature along the steepest and flattest cornea meridian and overall cornea astigmatism were compared. RESULTS: The curvature along the steepest meridian changed from 44.25 +/- 2.22D preoperatively to 44.08 +/- 2.16D at 3 months postoperatively, and 43.65 +/- 5.23D at 1 year postoperatively (P>0.05); the curvature along the flattest meridian changed from 41.24 +/- 2.21D preoperatively to 43.15 +/- 3.94D at 3 months postoperatively, and 42.85 +/- 5.17D at 1 year postoperatively (P<0.05); and the surgery induced astigmatism (SIA) on cornea was calculated by vector analysis, which was 2.42 +/- 2.13D at 3 months postoperatively, and 2.18 +/- 3.42D at 1 year postoperatively, the difference was statistically significant (P<0.05). CONCLUSION: The scleral flap made along the flattest meridian, under which the posterior chamber intraocular lenses (PCIOL) were sulcus-fixed by trans-scleral suture, can steepen the cornea in varying degrees, thus reducing preexisting corneal astigmatism.

Efficacy of scleral-fixated 3-looped haptics intraocular lens implantation for surgical management of microspherophakia

AIM:To evaluate the safety and efficacy of scleral-fixated 3-looped haptics intraocular lens(IOL)implantation for surgical management of microspherophakia.METHODS:A retrospective case series include 10 microspherophakic patients(15 eyes)who underwent lens removal plus a modified surgical treatment of scleral-fixated 3-looped haptics IOL implantation.The primary outcomes involved visual acuity,intraocular pressure(IOP).Secondary outcomes were spherical equivalent(SE),anterior chamber depth(ACD),corneal endothelial cell density and postoperative complications.RESULTS:After a postoperative follow-up of 17.60±15.44mo,improved visual outcomes can be observed.The uncorrected distance visual acuity(UCVA)log MAR improved from 1.54±0.59 preoperatively to 0.51±0.35 postoperatively(P=0.001),and best corrected visual acuity(BCVA)log MAR improved from 0.97±0.91 preoperatively to 0.24±0.23 postoperatively(P=0.003).Moreover,the SE decreased from-9.58±7.47D preoperatively to-0.65±2.21 D postoperatively(P<0.001).In terms of safety profile,the average IOP decreased from 21.10±12.94 mm Hg preoperatively to 14.03±3.57 mm Hg postoperatively(P=0.044),and the previously elevated IOP of three eyes decreased to the normal range.The ACD increased from 2.25±1.45 mm preoperatively to 3.35±0.39 mm postoperatively(P=0.017).The density of corneal endothelial cells did not change significantly after surgery(P=0.140).The posterior chamber IOLs were well centered and no severe complications were found.CONCLUSION:Lens removal plus the modified surgical treatment of scleral-fixated 3-looped haptics IOL implantation can help in improvement of visual acuity,which can be regarded as a relative safe method for the surgical management of microspherophakia.

LUtarjet-limit unique coracoid osteotomy Latarjet(With video)

Background:The Latarjet procedure is an effective technique for the treatment of recurrent anterior shoulder dislocation with glenoid bone loss.However,the inevitable destruction of the coracoacromial arch may result in humeral head translation.The aim of the study is to introduce a modified Latarjet technique with coracoacromial arch preservation as well as its short term clinical outcomes.Methods:We propose a novel individualized flexible arthroscopic suture button fixation Latarjet technique called‘LUtarjet’with video.Precise measurements of the coracoid process,glenoid deficiency and osteotomy plane were made preoperatively.Only three arthroscopic portals were needed and limit unique coracoid osteotomy was performed with coracoacromial arch preser-vation.The mini window splitting of the subscapularis was performed from the posterior to the anterior direction and the split window was as small as 8-10 mm in length.Results:A total of 27 patients(25.6±5.4 years)were included in the study.The average surgical durationwas 55.6±6.3 min and the mean follow-up timewas 8.1±1.5 months.The functional score was significantly improved at the last follow-up.Radiologic evidence showed that the bone graft healing was placed in the desired position.No complications were found.Conclusions:We present a fast,easy,accurate,safe arthroscopic‘LUtarjet’technique called FEAST that can simplify the arthroscopic Latarjet process and achieve a satisfactory bone graft position and satisfactory short-term clinical outcomes.Level of evidence:IV,case series.