Injury of the Infrapatellar Branch of Saphenous Nerve Between Vertical and Oblique Skin Incision in Medial Opening Wedge High Tibial Osteotomy

Introduction: The infrapatellar branch of saphenous nerve (IPBSN) has anatomic variations and prone to injury during surgery around the medial side of the knee. High tibial osteotomy is one of the procedures that may be risky to the IPBSN. This research was aimed to establish which skin incision (vertical vs oblique) is less likely to damage to the IPBSN and also to study the anatomy of the IPBSN, with the institutional review board reference (No. LH611054, date 10/1/2020). The primary outcomes are aimed to establish which skin incision (vertical vs oblique) is less damaging to the IPBSN. The secondary outcome is to study about the anatomy of the IPBSN. Materials and methods: Twenty-two fresh cadavers (forty- four knees) were dissected by randomisation under the block of four technique, and two different incisions were performed for each knee. Exploration was performed from the skin incision to the IPBSN around the incision zone. If the discontinuity of the nerve was found, it was classified as IPBSN injury. The anatomic measurement was performed. The IPBSN injury between two groups were analysed with the chi-square test. Results: The risk of IPBSN injury in the oblique group was 2 from 22 knees (9.1%), and 12 knees from 22 knees (54.5%) in the vertical group (P=0.001). Most common number of branch(es) found, is one branch, the horizontal distance ranged from 2.6cm to 8.5cm (average 5.7±1.6), the vertical distance ranged from 4.4cm to 12.6cm (average 7.6±1.9) and the declination angle ranged from 6° to 87° (average 34.7±24.3). Conclusion: The risk of the IPBSN injury in oblique skin incision may be less than the vertical incision in the medial opening wedge HTO

Double bundle arthroscopic Anterior Cruciate Ligament reconstruction with remnant preserving technique using a hamstring autograft

<p>Abstract</p> <p>Background</p> <p>Preservation of the Anterior Cruciate Ligament (ACL) remnant is important from the biological point of view as it enhances revascularization, and preserves the proprioceptive function of the graft construct. Additionally, it may have a useful biomechanical function. Double bundle ACL reconstruction has been shown to better replicate the native ACL anatomy and results in better restoration of the rotational stability than single bundle reconstruction.</p> <p>Methods</p> <p>We used the far anteromedial (FAM) portal for creation of the femoral tunnels, with a special technique for its preoperative localization using three dimensional (3D) CT. The central anteromedial (AM) portal was used to make a longitudinal slit in the ACL remnant to allow visualization of the tips of the guide pins during anatomical creation of the tibial tunnels within the native ACL tibial foot print. The use of curved hemostat allow retrieval of the wire loop from the apertures of the femoral tunnels through the longitudinal slit in the ACL remnant thereby, guarding against impingement of the reconstruction graft against the ACL remnant as well as the roof of the intercondylar notch.</p> <p>Conclusion</p> <p>Our technique allows for anatomical double bundle reconstruction of the ACL while maximally preserving the ACL remnant without the use of intra-operative image intensifier.</p

The lateral meniscus as a guide to anatomical tibial tunnel placement during anterior cruciate ligament reconstruction

Purpose: The aim of the study is to show, on an MRI scan, that the posterior border of the anterior horn of the lateral meniscus (AHLM) could guide tibial tunnel position in the sagittal plane and provide anatomical graft position. Method: One hundred MRI scans were analysed with normal cruciate ligaments and no evidence of meniscal injury. We measured the distance between the posterior border of the AHLM and the midpoint of the ACL by superimposing sagittal images. Results: The mean distance between the posterior border of the AHLM and the ACL midpoint was -0.1mm (i.e. 0.1mm posterior to the ACL midpoint). The range was 5mm to -4.6mm. The median value was 0.0mm. 95% confidence interval was from -0.5 to 0.3mm. A normal, parametric distribution was observed and Intra- and inter-observer variability showed significant correlation (p<0.05) using Pearsons Correlation test (intra-observer) and Interclass correlation (inter-observer). Conclusion: Using the posterior border of the AHLM is a reproducible and anatomical marker for the midpoint of the ACL footprint in the majority of cases. It can be used intra-operatively as a guide for tibial tunnel insertion and graft placement allowing anatomical reconstruction. There will inevitably be some anatomical variation. Pre-operative MRI assessment of the relationship between AHLM and ACL footprint is advised to improve surgical planning.The article is available via Open Access.Published (Open Access

Clinical Outcome of Medial Opening Wedge Osteotomy with T-Locking Plate : Two Years Follow-Up

Objective: This study was undertaken to determine clinical outcome after medial opening wedge osteotomy with Tlocking plate, with two- year follow up. Twenty-two patients (22 knees) who underwent medial opening wedge osteotomy with T-locking plate (stainless steel 316L, 6 holes) for treatment of varus malalignment of the leg between March 2005 and April 2008 were included in the study. The amount of correction ranged from 7° to 19° (mean, 9.77°). Clinical and radiographic findings were evaluated with VAS and the Lysholm score at sixth, twelfth and twenty- fourth months. Follow-up ranged from 18 to 37 months (mean, 2.1 years). Significant reduction was observed of VAS, from 4 (range:3.5-5) to almost free of symptoms (1.0 to 0.5) at the twentyfourth month follow-up (P<0.01). Good results were achieved in the Lysholm score (P<0.01). Medial opening wedge osteotomy with T-locking plate is safe and efficient procedure for corrective varus deformity of knee

Risk of Axillary Nerve Injury in Standard Anterolateral Approach of Shoulder: Cadaveric StudyRisk of Axillary Nerve Injury in Standard Anterolateral Approach of Shoulder: Cadaveric Study

Introduction: The anterolateral acromion approach of the shoulder is popular for minimally invasive plate osteosynthesis (MIPO) technique. However, there are literatures describing the specific risks of injury of the axillary nerve using this approach. Nevertheless, most of the studies were done with Caucasian cadavers. So, the purpose of this study was to evaluate the risk of iatrogenic axillary nerve injury from using the anterolateral shoulder approach and further investigate the location of the axillary nerve, associated with its location and arm length in the Asian population that have shorter arm length compared to the Caucasian population. Materials and Methods: Seventy-nine shoulders in fourty-two embalmed cadavers were evaluated. The bony landmarks were drawn, and a vertical straight incision was made 5cm from tip of the acromion (anterolateral approach), to the bone. The iatrogenic nerve injury status and the distance between the anterolateral edge of the acromion to the axillary nerve was measured and recorded. Results: In ten of the seventy-nine shoulders, the axillary nerve were iatrogenically injured. The average anterior distance was 6.4cm and the average arm length was 30.2cm. The anterior distance and arm length ratio was 0.2. Conclusion: Our results demonstrated that the recommended safe zone at 5cm from tip of acromion was not suitable with Asian population due to shorter arm length, compared to Caucasian population. The location of axillary nerve could be predicted by 20% of the total arm-length

Management of metastatic castration-resistant prostate cancer: Insights from urology experts in Thailand

Treatment options for castration-resistant prostate cancer (CRPC) are available, but clear instructions for the selection of appropriate treatment are lacking. A meeting of urology experts based in Thailand was convened with the following objectives: (1) to reach a consensus and share real-life experiences about how to identify CRPC; (2) to choose the appropriate treatment for CRPC patients; (3) to evaluate disease progression using novel inhibitors of the androgen receptor pathway; (4) to identify the frequency of monitoring disease; and (5) to promote rational use of corticosteroids in CRPC patients. This consensus document can provide guidance to other urologists in Thailand to provide appropriate treatment to metastatic CRPC patients in a timely manner